Diffuse large B-cell lymphoma is the most common form of B-cell non-Hodgkin lymphoma. DLBCL can be treated with a variety of therapies, but the goal is generally a complete response. Doctors may measure how successful your treatment was and predict your outcomes by determining whether you had a complete response or a partial response after a round of treatment.
Doctors may say that you have a complete response or complete remission if, after treatment, all signs of your lymphoma disappear. This means that you no longer have any symptoms, and tests can’t detect any cancer cells or other indicators of DLBCL.
A CR doesn’t necessarily mean that your DLBCL has been cured. It’s possible that a very small number of lymphoma cells survived treatment and remain behind. There may be so few cancer cells that they can’t be detected with tests, but these cancer cells could still come back later and begin growing again in what is known as a relapse or recurrence.
Among people who have a complete response, less than 1 out of 5 will relapse within five years.
A partial response or partial remission occurs when treatment helps kill some cancer cells, but others remain. Your doctor may say you’re in partial remission if less than half of your lymphoma remains after you go through treatment.
For example, DLBCL may cause cancer to grow in your lymph nodes and other organs such as your spleen or bone marrow. You may have a partial response if treatment shrinks some of your lymph nodes but not others, or if cancer can no longer be found in certain lymph nodes but tests still detect cancer cells in other tissues. In this case, lymphoma symptoms may disappear or they may persist.
In some cases, your lymphoma may not respond at all to treatment — it either stays the same or it progresses and worsens. When this happens, you don’t have a complete or partial response. Instead, doctors say that your DLBCL is refractory.
Whether or not you experience a CR affects your prognosis (outlook). People who go into complete response are more likely to experience good outcomes and have a lower chance of relapsing. Four out of 5 people with DLBCL who go into CR will live at least five years after their initial diagnosis. Doctors refer to this time period as event-free survival.
Other factors can also influence your DLBCL prognosis, including:
Is Complete Response the Goal of Treatment?
DLBCL is considered a high-grade form of non-Hodgkin lymphoma. In other words, it is an aggressive lymphoma that grows quickly. Oncologists (doctors specializing in cancer) generally aim for a CR when treating high-grade non-Hodgkin lymphoma. These forms of cancer can often go into complete remission or even be cured.
More than 3 out of 4 people with DLBCL reach complete remission after using the standard R-CHOP treatment regimen, according to a 2022 study in Blood Cancer Journal. R-CHOP consists of a monoclonal antibody drug, rituximab (Rituxan), combined with four types of chemotherapy — cyclophosphamide (Cytoxan), doxorubicin (Adriamycin — also called hydroxydaunorubicin), vincristine (Oncovin), and prednisolone (Omnipred). This initial treatment that you receive after diagnosis is called front-line or first-line treatment.
For people with relapsed or refractory disease, the goal of treatment may change. Lymphoma that doesn’t respond to therapy is hard to recover from, and most people with this type of high-risk DLBCL are more likely to have a poor prognosis. In this case, your doctor may give you other types of therapies — called second-line treatment — to try to keep your condition under control for as long as possible.
Doctors can’t predict just how long you will be in remission. Length of remission can depend on many risk factors, including:
The longer your CR lasts, the lower your chances are of experiencing a relapse. If your lymphoma does relapse, it’s best to detect it and start treatment as soon as possible. It’s important to attend all regular follow-up appointments and get tests to look for any signs that your DLBCL has returned.
People are more likely experience a DLBCL relapse within two years after treatment. Therefore, your doctor may recommend follow-up visits every couple of months during this period. After that, you may need to be seen just once or twice a year. After three to five years, you may not need to keep undergoing tests to look for signs of lymphoma. However, you should always tell your doctor right away if you think that any lymphoma symptoms have returned.
If you have primary refractory disease (your lymphoma doesn’t respond to treatment and you never reach CR) or your DLBCL relapses, you may be able to try different treatment options.
Refractory DLBCL and DLBCL that relapses within a year of the start of treatment may require aggressive treatments. Your doctor may recommend options such as chimeric antigen receptor (CAR) T-cell therapy, in which your immune cells are trained to better recognize and attack cancer cells.
When DLBCL relapses more than a year after you were initially treated, you may be able to try chemotherapy again, as well as other treatments like CAR T-cell therapy or a bone marrow transplant. During bone marrow transplantation, healthy bone marrow cells from your own body are re-administered after high-dose chemotherapy. The bone marrow cells help produce healthy blood cells.
People with relapsed or refractory DLBCL may also be able to enroll in oncology clinical trials that offer new treatment options, such as novel forms of chemoimmunotherapy. Novel drugs are chemically different from those already approved by the U.S. Food and Drug Administration (FDA). Your health care provider can tell you more about clinical trials and other possible treatments for DLBCL.
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