Diffuse (non-Hodgkin) large B-cell lymphoma is a type of non-Hodgkin's lymphoma. Diffuse large B-cell lymphoma (DLBCL) is the most frequently diagnosed type of cancer of the lymphatic system - 35 percent. In turn, as much as 80 percent. Aggressive lymphoma is DLBCL. What are the causes and symptoms of diffuse large B-cell lymphoma? What is the treatment?

Diffuse (non-Hodgkin) large B-cell lymphomais a type of non-Hodgkin's lymphoma. Diffuse large B-cell lymphoma (DLBCL) is the most frequently diagnosed type of cancer of the lymphatic system - 35 percent. In turn, as much as 80 percent. Aggressive lymphomas are DLBCL.

Lymphoma is a cancer of the lymphatic system (which is part of the immune system) characterized by the uncontrolled growth of white blood cells (B or T lymphocytes), the correct number of which in a he althy body helps us fight infection.

Diffuse (non-Hodgkin) large B-cell lymphoma is a cancer caused by the proliferation of B cells.

In Poland, nearly 7,500 new cases of lymphoma are diagnosed every year. Thanks to the progress of medicine, in many cases we are able to overcome them. Polish patients do not have access to effective treatment of aggressive - refractory to the current treatment or recurrent B-cell non-Hodgkin lymphoma.

Diffuse large B-cell lymphoma - causes

The causes of B-cell non-Hodgkin's lymphoma (DLBCL) are unknown. The likely risk factors include:

This disease in more than 50 percent. is diagnosed in people over 65 years of age,

  • viral and bacterial infections
  • high-fat diet
  • ionizing radiation
  • chemical exposures
  • previous anti-cancer treatment
  • taking immunosuppressive drugs

Diffuse large B-cell lymphoma - symptoms

Lymphoma is an insidious tumor that can be difficult to detect due to non-specific symptoms (often typical of the common cold). These include:

Often the first symptom of this disease is painless swelling in the neck, armpits and groin caused byby enlarged lymph nodes.

  • painless enlargement of the lymph nodes
  • elevated temperature
  • dry and persistent cough
  • recurring infections of the upper respiratory tract and lungs
  • weakness
  • feeling short of breath
  • night sweats
  • significant weight loss in a short time
  • digestive system disorders
  • itchy skin

Non-specific symptoms mean that this neoplasm is often diagnosed in the advanced stage. Most DLBCL patients see a doctor because of painless enlargement of the lymph nodes (60%) and / or the presence of a tumor in the extra-nodal area (40%), as well as due to the presence of non-specific general symptoms of the disease (fever, night sweats, cough). , feeling short of breath, losing weight).

Diffuse large B-cell lymphoma - diagnosis

The final diagnosis is made after the histopathological and immunohistochemical examination of the lymph node or other tissue of the organ affected by the tumor (e.g. stomach, tonsils). For this purpose, it is necessary to perform an organ biopsy or surgical removal of the entire lymph node with a bag. Additional information about the disease can be obtained, for example, with blood and bone marrow tests.

Diffuse large B-cell lymphoma - treatment

Diffuse large B-cell lymphoma (DLBCL), being an aggressive lymphoma, unlike indolent (low-grade, slowly progressing) lymphoma, requires radical measures - stopping the disease and making efforts to cure it completely.

In most cases, immunochemotherapy (R-CHOP) and possibly radiotherapy are the standard in the treatment of 1st degree non-Hodgkin's lymphomas. Immunochemotherapy consists in the simultaneous administration of chemotherapy (cytostatics) and monoclonal antibodies (rituximab), which gives a chance of permanent cure even in 60-70% of patients. patients. This therapy is available in Poland as part of a therapeutic program financed by the National He alth Fund.

The real drama is the case of relapsed or refractory lymphomas, which account for approximately 30-35 percent of DLBCL. In such a situation, patients in good he alth can be offered high-dose immunochemotherapy - chemotherapeutic agents administered without rituximab do not give much effect. Completion of such treatment can be a bridge for the patient to undergo a bone marrow transplant.

What about patients who have not responded to the above treatment and have a second or third relapse?The opportunity for them is pixantrone, which is a response to the existing unmet medical needs. Currently, this therapeutic option is missing in Poland. The treatment used so far in relapsed lymphoma (DLBCL) has resulted in a low response rate of 5 percent.

Pixantrone (approved in the 3rd and 4th lines of treatment) is the only drug with EMA indication for monotherapy treatment of patients with repeatedly relapsed or refractory aggressive B-cell non-Hodgkin's lymphoma in adults. Pixantrone is a new generation cytostatics with a different mechanism of action compared to the classic, registered anthracyclines (doxorubicin and others). The drug is characterized by reduced cardiotoxicity. This is of great importance for seniors who often have cardiovascular diseases together with cancer, as well as for people who have previously been treated with cardiotoxic anthracyclines.

Importantly, this therapy can also be a bridge to bone marrow transplant, thus giving you a chance for a permanent cure.

Data from Phase III clinical trials involving 140 patients showed a significant (40%) improvement in progression-free survival (PFS) compared to the control group. Patients treated with pixantrone achieved long-term or complete remissions - mean duration 9.6 months. In contrast, progression-free survival was 5.3 months, and the mean overall survival was 10.2 months. The drug has a predictable and manageable safety profile.

It is worth emphasizing that patients are not treated with pixantrone for the rest of their lives. The median duration of drug use according to phase III studies was 4 months. Only 32 percent. patients in this study received 6 cycles.

The

Committee for Medicinal Products for Human Use (CHMP) concluded that patients receiving pixantrone show a better response to treatment than other cancer treatments - living longer without their disease worsening. Pixantrone has been positively assessed by the British NICE agency.

In Poland, pixantrone - as a drug of only chance in the treatment of relapsed aggressive large B-cell lymphoma - is indicated for a relatively small group of patients. The projected number of patients is around 200-300 people.

Today, Polish patients can take advantage of the drug's benefits only as part of clinical trials. Pixantrone is already available in over a dozen EU countries, including Slovakia, Slovenia and Greece, in countries where the GDP level is similar to ours. In Poland, the drug is not reimbursed yet. Currently, patients with refractory orrelapsed large B-cell lymphoma, for which, for various reasons, bone marrow transplantation cannot be performed, or if the disease is still active despite the transplantation, they can practically only be treated palliatively - with traditional chemotherapy.

Positive decisions are awaited by patients, their relatives and doctors who are aware that this type of lymphoma, if not treated, becomes a sentence for the patient within a few months.

Category:

Oncology