Treatment Protocols

Treatment recommendations for patients with diffuse large B-cell lymphoma (DLBCL) begin with evaluating the extent of the disease, performance status of the patient, and histologic subtypes. Treatment of localized and advanced disease varies considerably.

Below is a general treatment algorithm for DLBCL, followed by treatment recommendations for different stages of disease and for relapsed or refractory disease.^{[1, 2, 3]}

General DLBCL treatment algorithm

Diagnosis of DLBCL:

Staging/IPI score/bulky disease
Assess end-organ function
Establish therapy endpoints (ie, cure vs palliation)

Stage I/II (nonbulky) disease:

Rituximab (R) plus cyclophosphamide, vincristine, doxorubicin, and prednisone (CHOP) for 3-4 cycles
Follow with involved field radiation therapy (IFRT)
If positron emission tomography (PET) is positive after 4 cycles, administer 2 more cycles before IFRT
If relapse occurs, see step 4

Advanced-stage (stage III-IV) or bulky stage II disease:

R+CHOP every 21 d for 6 cycles, with or without IFRT for bulky sites
Prophylactic intrathecal (IT) chemotherapy in selected cases or
Clinical trial with correlative science studies (eg, R+CHOP-like and other biological agents or small molecules and/or other novel monoclonal antibodies [mAbs] or immunoconjugates)

In cases of relapse:

Staging/IPI score/bulky disease
Assess end-organ function

In relapse patients, collect lymphoid tissue and store for future analysis or current research evaluating gene profiling, proteomic analysis, biomarkers of disease (MUM-1, Bcl-6, and CD10), and preclinical studies with novel agents

Relapse patients eligible for high-dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT):

Platinum-based salvage chemotherapy, ^[4]including rituximab, ifosfamide, carboplatin, and etoposide (RICE) for 2-3 cycles or
Rituximab plus cisplatin, cytarabine, and dexamethasone (DHAP) for 2-3 cycles
If partial or complete response is achieved, use HDC and ASCT
Observation or clinical trials evaluating agents in the maintenance setting may be recommended
If patient relapses, consider clinical trials evaluating novel agents (eg, bortezomib, lenalidomide, or immunoconjugates) or
Radioimmunotherapy (RIT)

Relapse patients not eligible for HDC and ASCT:

Palliative chemotherapy (gemcitabine-based therapyClinical trials evaluating novel agents (eg, bortezomib, lenalidomide, or immunoconjugates) or
RIT

Treatment recommendations for early-stage disease

Stage I and selected stage II:

Patients without adverse risk factors present:

R+CHOP: Combined therapy with rituximab 375 mg/m² IV on day 1 plus cyclophosphamide 750 mg/m² IV on day 1 or 3 plus doxorubicin 50 mg/m² IV on day 1 or 3 plus vincristine 1.4 mg/m² (maximum dose, 2 mg) IV on day 1 or 3 plus prednisone 40 mg/m² PO on days 1-5 or 3-8; every 21d for 3 cycles^[5]
Radiographic studies including functional imaging (eg, PET scan) to document response to treatment should be done before initiation of IFRT and/or at the end of therapy
Always confirm residual PET abnormalities with biopsy before modifying therapy

Patients with adverse risk factors present:

R+CHOP: Combined therapy with rituximab plus cyclophosphamide 750 mg/m² IV on day 1 or 3 plus doxorubicin 50 mg/m² IV on day 1 or 3 plus vincristine 1.4 mg/m² (maximum dose, 2 mg) IV on day 1 or 3 plus prednisone 40 mg/m² PO on days 1-5 or 3-8; every 21d for 3 cycles followed by IFRT^[5]or
R+CHOP: Rituximab 375 mg/m² IV on day 1 plus cyclophosphamide 750 mg/m² IV on day 1 or 3 plus doxorubicin 50 mg/m² IV on day 1 or 3 plus vincristine 1.4 mg/m² (maximum dose, 2 mg) IV on day 1 or 3 plus prednisone 40 mg/m² PO on days 1-5 or 3-8; every 21d for 6 cycles with or without IFRT^[6]
Radiographic studies including functional imaging (eg, PET scan) to document response to treatment should be done before initiation of IFRT and/or at the end of therapy
Always confirm residual PET abnormalities with biopsy before modifying therapy

Treatment recommendations for advanced-stage disease

Stages III-IV:

R+CHOP: Rituximab 375 mg/m² IV on day 1 plus cyclophosphamide 750 mg/m² IV on day 1 or 3 plus doxorubicin 50 mg/m² IV on day 1 or 3 plus vincristine 1.4 mg/m² (maximum dose, 2 mg) IV on day 1 or 3 plus prednisone 40 mg/m² PO on days 1-5 or 3-8; every 21d for 6 cycles with or without IFRT^{[6, 7]}
Consider radiation therapy to bulky sites of disease at the end of chemoimmunotherapy

Prophylactic intrathecal chemotherapy (selected cases)

Prophylactic IT chemotherapy with low-dose methotrexate (eg, 12 mg) should be routinely administered to DLBCL patients with the following characteristics^{[8, 9]}:

More than one extranodal site of disease
Testicular or breast involvement, regardless of stage
Lymphoblastic variants
Oropharyngeal or paraspinal sites of involvement
Bone marrow involvement
Concomitant HIV infection

Treatment recommendations for relapsed or refractory disease

Patients eligible for HDC-ASCT (treatment goal = cure):

A vast number of regimens are used in the treatment of patients with relapsed or refractory DLBCL. These are primarily based on chemotherapy agents that are not cross-resistant to those used in the front-line setting, with or without rituximab. The goal of salvage regimens is to achieve maximum tumor burden cytoreduction in preparation for HDC with ASCT (HDC-ASCT).^[10]

RICE: Rituximab 375 mg/m² day 1 plus ifosfamide 5 g/m² on day 2 plus carboplatin AUC 5 plus etoposide 100 mg/m² daily on days 1-3; every 14 d^[11](see also the Carboplatin AUC Dose Calculation [Calvert formula] calculator) or
ICE: Ifosfamide 5 g/m² on day 2 plus carboplatin AUC 5 plus etoposide 100 mg/ m² daily on days 1-3; every 14d^[12] or
GDP: Gemcitabine 1000 mg/m² on days 1 and 8 plus dexamethasone 40 mg on days 1-4 plus cisplatin 75 mg/m² on day 1; every 21d^[13] or
GEM-P: Gemcitabine 1000 mg/m² on days 1 and 8 plus methylprednisolone 1000 mg/m² on days 1-5 plus cisplatin 100 mg/m² on day 15; every 28 d^{[14, 15]} or
Gem-P: Gemcitabine 1000 mg/m² on days 1 and 8 plus cisplatin 100 mg/m² on day 1; every 21d^{[16, 17]}or
R+GEMOX: Rituximab 375 mg/m²plus gemcitabine 1000 mg/m²plus oxaliplatin 100 mg/m² on day 1; every 14 d^[17] or
ESHAP: Etoposide 40 mg/m²/day plus methylprednisolone 500 mg/day plus cisplatin 25 mg/m²/day by continuous IV infusion (CIVI) for 4 d plus cytarabine (Ara-C) 2 g/m² on day 5^[18] or
DHAP: Dexamethasone 40 mg on days 1-4 plus cytarabine 2 g/m² every 12h for 2 doses on day 2 plus cisplatin 100 mg/m² on day 1; every 21d^[19] or
R-DHAP: Dexamethasone 40 mg on days 1-4 plus cytarabine 2 g/m² every 12h for 2 doses on day 2 plus cisplatin 100 mg/m² on day 3; every 21 d plus rituximab 375 mg/m² weekly for 4 wk starting on day 1 of first cycle^[20]or
R-DHAP-VIM-DHAP: Cisplatin 100 mg/m² on day 1 by continuous IV infusion plus cytarabine 2 g/m² every 12 h for 2 doses on day 2 plus dexamethasone 40 mg/day on days 1-4; VIM = etoposide 90 mg/m² on days 1, 3, and 5 plus ifosfamide 1200 mg/m² IV on days 1-5 plus methotrexate 30 mg/m² IV on days 1 and 5; rituximab 375 mg/m² is administered on day 5 of the DHAP courses or on day 6 of the VIM course^[21] or
DHAP-VIM-DHAP: Cisplatin 100 mg/m² on day 1 by continuous IV infusion plus cytarabine 2 g/m² every 12 h for 2 doses on day 2 plus dexamethasone 40 mg/day on days 1-4; VIM = etoposide 90 mg/m² on days 1, 3, and 5 plus ifosfamide 1200 mg/m² IV on days 1-5 plus methotrexate 30 mg/m² IV on days 1 and 5^[21]
Polatuzumab vedotin 1.8 mg/kg IV on Day 1 plus rituximab 375 mg/m² IV on Day 1 plus bendamustine 90 mg/m²/day on Days 1 and 2 every 21d for 6 cycles; may administer polatuzumab, bendamustine, and rituximab in any order on Day 1 of each cycle^[22]
Loncastuximab 0.15 mg/kg IV q3Weeks × 2 cycles, then 0.075 mg/kg IV q3Weeks thereafter^[23]

CAR T-cell therapy (treatment goal = cure):

Tisagenlecleucel 0.6-6 × 10 ⁸ CAR-positive viable T cells/kg IV infusion at rate of 10-20 mL/min; administer 2-11 days after completing lymphodepleting chemotherapy ^{[24, 25, 26]}
Axicabtagene ciloleucel 2 × 10 ⁶ CAR-positive viable T cells/kg body weight, not to exceed 2 × 10 ⁸ CAR-positive viable T cells; infuse IV over 30 min 3 days after completing lymphodepleting chemotherapy ^[27]
Lisocabtagene maraleucel 50-110 × 10 ⁶ CAR-positive viable T-cells/kg; administer 2-7 days after completing lymphodepleting chemotherapy ^[28]

Patients not eligible for HDC-ASCT (treatment goal = palliation):

GV: Gemcitabine 1000 mg/m²plus vinorelbine 30 mg/m² on days 1 and 8; every 21 d^[29]or
GVP: Gemcitabine 1000 mg/m²plus vinorelbine 30 mg/m² on days 1 and 8 plus prednisone 100 mg on days 1-8; every 21d^[30] or
ViGePP: Vinorelbine 25 mg/m²plus gemcitabine 800 mg/m² on days 1 and 8 plus procarbazine 100 mg/m² on days 1-7 plus prednisone 60 mg/m² on days 1-15; every 28 d^[31] or
IEV: Ifosfamide 2500 mg/m²plus etoposide 150 mg/m² on days 1-3 plus epirubicin 100 mg/m² on day 1; every 21 d^{[31, 32]} or
MINE: Ifosfamide 2660 mg/m²/day on days 1-3 plus etoposide 300 mg/m² in 1 dose on days 1-3; followed by ifosfamide 3300mg/m² on days 1-3 plus mitoxantrone 20 mg/m² on day 1 if less than complete response is achieved^[33] or
IVAD: Ifosfamide 1500 mg/m²plus etoposide 100 mg/m²plus cytarabine 100 mg/m²plus dexamethasone 40 mg on days 1-5; every 21d^[34]or
Mini-BEAM: Busulfan 60 mg/m² on day 1 plus etoposide 75 mg/m² on days 2-5 plus cytarabine 100 mg/m² every 12h on days 2-5 plus melphalan 30 mg/m² on day 6; every 28d^{[35, 36]} or
EPOCH: Doxorubicin 10 mg/m²plus etoposide 50 mg/m²plus vincristine 0.4 mg/m² by continuous IV infusion on days 2-4 plus cyclophosphamide 750 mg/m² on day 6 plus prednisone 60 mg/m² on days 1-6; every 21 d^[37] or
R-EPOCH: Rituximab 375 mg/m² IV on day 1 plus doxorubicin 15 mg/m²plus etoposide 65 mg/m²plus vincristine 0.5 mg/day by continuous IV infusion on days 2-4 plus cyclophosphamide 750 mg/m² on day 5 plus prednisone 60 mg/m² on days 1-14; every 21d^[38] or
Lenalidomide 25 mg PO on days 1-21; every 28 d until progression or unacceptable toxicity^[39]
Lenalidomide 25 mg PO on days 1-21; every 28 days for a maximum of 12 cycles plus tafasitamab 12 mg/kg IV (actual body weight) on Days 1, 4, 8, 15, and 22 (Cycle 1), then Days 1,8,15, and 22 (Cycles 2-3), then Days 1 and 15 (Cycle 4 and thereafter); continue as monotherapy until disease progression or unacceptable toxicity ^[40]

Patients with relapsed or refractoryDLBCL, not otherwise specified, including DLBCL arising from follicular lymphoma, after at least 2 lines of systemic therapy:

Selinexor 60 mg PO on Days 1 and 3 of each week; continue until disease progression or unacceptable toxicity ^[41]

Patients with relapsed or refractory DLBCL, not otherwise specified, including DLBCL not otherwise specified, DLBCL arising from low-grade lymphoma, and high-grade B-cell lymphoma:

Loncastuximab 0.15 mg/kg IV q3Weeks x 2 cycles, then 0.075 mg/kg IV q3Weeks thereafter ^[23]

Questions & Answers

Overview

Which factors affect treatment selection in diffuse large B-cell lymphoma (DLBCL)?

What is the diffuse large B-cell lymphoma (DLBCL) treatment algorithm?

What are the treatment recommendations for early-stage diffuse large B-cell lymphoma (DLBCL) without adverse risk factors?

What are the treatment recommendations for early-stage diffuse large B-cell lymphoma (DLBCL) with adverse risk factors?

What are the treatment recommendations for advanced-stage diffuse large B-cell lymphoma (DLBCL)?

When is prophylactic IT chemotherapy indicated in the treatment of diffuse large B-cell lymphoma (DLBCL)?

What are the treatment recommendations for relapsed or refractory diffuse large B-cell lymphoma (DLBCL) prior to HDC-ASCT?

What are the recommendations for CAR T-cell therapy in the treatment of relapsed or refractory diffuse large B-cell lymphoma (DLBCL)?

What are the treatment recommendations for relapsed or refractory diffuse large B-cell lymphoma (DLBCL) in patients not eligible for HDC-ASCT?

Jaffe ES. The 2008 WHO classification of lymphomas: implications for clinical practice and translational research. Hematology Am Soc Hematol Educ Program. 2009. 523-31. [QxMD MEDLINE Link].
Rosenwald A, Wright G, Chan WC, et al. The use of molecular profiling to predict survival after chemotherapy for diffuse large-B-cell lymphoma. N Engl J Med. 2002 Jun 20. 346(25):1937-47. [QxMD MEDLINE Link].
A predictive model for aggressive non-Hodgkin's lymphoma. The International Non-Hodgkin's Lymphoma Prognostic Factors Project. N Engl J Med. 1993 Sep 30. 329(14):987-94. [QxMD MEDLINE Link].
Kuruvilla J, MacDonald DA, Kouroukis CT, Cheung M, Olney HJ, Turner AR, et al. Salvage chemotherapy and autologous stem cell transplantation for transformed indolent lymphoma: a subset analysis of NCIC CTG LY12. Blood. 2015 Aug 6. 126 (6):733-8. [QxMD MEDLINE Link].
Persky DO, Unger JM, Spier CM, et al. Phase II study of rituximab plus three cycles of CHOP and involved-field radiotherapy for patients with limited-stage aggressive B-cell lymphoma: Southwest Oncology Group study 0014. J Clin Oncol. 2008 May 10. 26(14):2258-63. [QxMD MEDLINE Link].
Pfreundschuh M, Trümper L, Osterborg A, et al. CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera International Trial (MInT) Group. Lancet Oncol. 2006 May. 7(5):379-91. [QxMD MEDLINE Link].
Coiffier B, Lepage E, Briere J, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med. 2002 Jan 24. 346(4):235-42. [QxMD MEDLINE Link].
van Besien K, Ha CS, Murphy S, et al. Risk factors, treatment, and outcome of central nervous system recurrence in adults with intermediate-grade and immunoblastic lymphoma. Blood. 1998 Feb 15. 91(4):1178-84. [QxMD MEDLINE Link].
Boehme V, Zeynalova S, Kloess M, et al. Incidence and risk factors of central nervous system recurrence in aggressive lymphoma--a survey of 1693 patients treated in protocols of the German High-Grade Non-Hodgkin's Lymphoma Study Group (DSHNHL). Ann Oncol. 2007 Jan. 18(1):149-57. [QxMD MEDLINE Link].
Philip T, Guglielmi C, Hagenbeek A, et al. Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-Hodgkin's lymphoma. N Engl J Med. 1995 Dec 7. 333(23):1540-5. [QxMD MEDLINE Link].
Kewalramani T, Zelenetz AD, Nimer SD, et al. Rituximab and ICE as second-line therapy before autologous stem cell transplantation for relapsed or primary refractory diffuse large B-cell lymphoma. Blood. 2004 May 15. 103(10):3684-8. [QxMD MEDLINE Link].
Moskowitz CH, Bertino JR, Glassman JR, et al. Ifosfamide, carboplatin, and etoposide: a highly effective cytoreduction and peripheral-blood progenitor-cell mobilization regimen for transplant-eligible patients with non-Hodgkin's lymphoma. J Clin Oncol. 1999 Dec. 17(12):3776-85. [QxMD MEDLINE Link].
Crump M, Baetz T, Couban S, et al. Gemcitabine, dexamethasone, and cisplatin in patients with recurrent or refractory aggressive histology B-cell non-Hodgkin lymphoma: a Phase II study by the National Cancer Institute of Canada Clinical Trials Group (NCIC-CTG). Cancer. 2004 Oct 15. 101(8):1835-42. [QxMD MEDLINE Link].
Chau I, Harries M, Cunningham D, et al. Gemcitabine, cisplatin and methylprednisolone chemotherapy (GEM-P) is an effective regimen in patients with poor prognostic primary progressive or multiply relapsed Hodgkin's and non-Hodgkin's lymphoma. Br J Haematol. 2003 Mar. 120(6):970-7. [QxMD MEDLINE Link].
Barton S, Hawkes EA, Cunningham D, Peckitt C, Chua S, Wotherspoon A, et al. Rituximab, Gemcitabine, Cisplatin and Methylprednisolone (R-GEM-P) is an effective regimen in relapsed diffuse large B-cell lymphoma. Eur J Haematol. 2015 Mar. 94 (3):219-26. [QxMD MEDLINE Link].
Ng M, Waters J, Cunningham D, et al. Gemcitabine, cisplatin and methylprednisolone (GEM-P) is an effective salvage regimen in patients with relapsed and refractory lymphoma. Br J Cancer. 2005 Apr 25. 92(8):1352-7. [QxMD MEDLINE Link].
López A, Gutiérrez A, Palacios A, et al. GEMOX-R regimen is a highly effective salvage regimen in patients with refractory/relapsing diffuse large-cell lymphoma: a phase II study. Eur J Haematol. 2008 Feb. 80(2):127-32. [QxMD MEDLINE Link].
Soussain C, Souleau B, Gabarre J, et al. Intensive chemotherapy with hematopoietic cell transplantation after ESHAP therapy for relapsed or refractory non-Hodgkin's lymphoma. Results of a single-centre study of 65 patients. Leuk Lymphoma. 1999 May. 33(5-6):543-50. [QxMD MEDLINE Link].
Olivieri A, Brunori M, Capelli D, et al. Salvage therapy with an outpatient DHAP schedule followed by PBSC transplantation in 79 lymphoma patients: an intention to mobilize and transplant analysis. Eur J Haematol. 2004 Jan. 72(1):10-7. [QxMD MEDLINE Link].
Witzig TE, Geyer SM, Kurtin PJ, et al. Salvage chemotherapy with rituximab DHAP for relapsed non-Hodgkin lymphoma: a phase II trial in the North Central Cancer Treatment Group. Leuk Lymphoma. 2008 Jun. 49(6):1074-80. [QxMD MEDLINE Link].
Vellenga E, van Putten WL, van 't Veer MB, et al. Rituximab improves the treatment results of DHAP-VIM-DHAP and ASCT in relapsed/progressive aggressive CD20+ NHL: a prospective randomized HOVON trial. Blood. 2008 Jan 15. 111(2):537-43. [QxMD MEDLINE Link].
Sehn LH, Herrera AF, Matasar MJ, et al. Addition of polatuzumab vedotin to bendamustine and rituximab (BR) improves outcomes in transplant-ineligible patients with relapsed/refractory (r/r) diffuse large B-cell lymphoma (DLBCL) versus BR alone: Results from a randomized phase 2 study. Blood. 2017. 130:2821. [Full Text].
Spira AI, Chen L, Zhou X, Gnanasakthy A, Wang L, Ungar D, et al. Symptoms, health-related quality of life, and tolerability of loncastuximab tesirine in patients with relapsed or refractory diffuse large B cell lymphoma. Blood 2020;136(suppl 1):3-4. [Full Text].
Schuster SJ, Bishop MR, Tam CS, et al. Primary Analysis of Juliet: A Global, Pivotal, Phase 2 Trial of CTL019 in Adult Patients with Relapsed or Refractory Diffuse Large B-Cell Lymphoma. Blood. 2017. 130 (Supplement 1): 577:[Full Text].
Schuster SJ, Svoboda J, Chong EA, Nasta SD, Mato AR, Anak Ö, et al. Chimeric Antigen Receptor T Cells in Refractory B-Cell Lymphomas. N Engl J Med. 2017 Dec 28. 377 (26):2545-2554. [QxMD MEDLINE Link]. [Full Text].
Schuster SJ, et al; JULIET Investigators. Tisagenlecleucel in Adult Relapsed or Refractory Diffuse Large B-Cell Lymphoma. N Engl J Med. 2019 Jan 3. 380 (1):45-56. [QxMD MEDLINE Link].
Neelapu SS, Locke FL, Bartlett NL, Lekakis LJ, Miklos DB, Jacobson CA, et al. Axicabtagene Ciloleucel CAR T-Cell Therapy in Refractory Large B-Cell Lymphoma. N Engl J Med. 2017 Dec 28. 377 (26):2531-2544. [QxMD MEDLINE Link].
TRANSFORM Trial: Lisocabtagene Maraleucel vs Standard of Care for Relapsed or Refractory Large B-Cell Lymphoma. The ASCO Post. Available at https://ascopost.com/news/december-2021/transform-trial-lisocabtagene-maraleucel-vs-standard-of-care-for-relapsed-or-refractory-large-b-cell-lymphoma/?utm_source=pushly. December 11, 2021; Accessed: December 20, 2021.
Papageorgiou ES, Tsirigotis P, Dimopoulos M, et al. Combination chemotherapy with gemcitabine and vinorelbine in the treatment of relapsed or refractory diffuse large B-cell lymphoma: a phase-II trial by the Hellenic Cooperative Oncology Group. Eur J Haematol. 2005 Aug. 75(2):124-9. [QxMD MEDLINE Link].
Müller-Beissenhirtz H, Kasper C, et al. Gemcitabine, vinorelbine and prednisone for refractory or relapsed aggressive lymphoma, results of a phase II single center study. Ann Hematol. 2005 Nov. 84(12):796-801. [QxMD MEDLINE Link].
Di Renzo N, Brugiatelli M, Montanini A, et al. Vinorelbine, gemcitabine, procarbazine and prednisone (ViGePP) as salvage therapy in relapsed or refractory aggressive non-Hodgkin’s lymphoma (NHL): results of a phase II study conducted by the Gruppo Italiano per lo Studio dei Linfomi. Leuk Lymphoma. 2006. 47:473-9.
Pocali B, De Simone M, Annunziata M, et al. Ifosfamide, epirubicin and etoposide (IEV) regimen as salvage and mobilization therapy for refractory or early relapsing patients with aggressive non-Hodgkin’s lymphoma. Leuk Lymphoma. 2004. 45:1605-9.
van Besien K, Rodriguez A, Tomany S, et al. Phase II study of a high-dose ifosfamide-based chemotherapy regimen with growth factor rescue in recurrent aggressive NHL. High response rates and limited toxicity, but limited impact on long-term survival. Bone Marrow Transplant. 2001. 27:397-404.
Schütt P, Passon J, Ebeling P, et al. Ifosfamide, etoposide, cytarabine, and dexamethasone as salvage treatment followed by high-dose cyclophosphamide, melphalan, and etoposide with autologous peripheral blood stem cell transplantation for relapsed or refractory lymphomas. Eur J Haematol. 2007 Feb. 78(2):93-101. [QxMD MEDLINE Link].
Girouard C, Dufresne J, Imrie K, et al. Salvage chemotherapy with mini-BEAM for relapsed or refractory non-Hodgkin's lymphoma prior to autologous bone marrow transplantation. Ann Oncol. 1997 Jul. 8(7):675-80. [QxMD MEDLINE Link].
Nieto Y, Valdez BC, Thall PF, Ahmed S, Jones RB, Hosing C, et al. Vorinostat Combined with High-Dose Gemcitabine, Busulfan, and Melphalan with Autologous Stem Cell Transplantation in Patients with Refractory Lymphomas. Biol Blood Marrow Transplant. 2015 Nov. 21 (11):1914-20. [QxMD MEDLINE Link].
Wilson WH, Bryant G, Bates S, et al. EPOCH chemotherapy: toxicity and efficacy in relapsed and refractory non-Hodgkin's lymphoma. J Clin Oncol. 1993 Aug. 11(8):1573-82. [QxMD MEDLINE Link].
Jermann M, Jost LM, Taverna Ch, et al. Rituximab-EPOCH, an effective salvage therapy for relapsed, refractory or transformed B-cell lymphomas: results of a phase II study. Ann Oncol. 2004 Mar. 15(3):511-6. [QxMD MEDLINE Link].
Witzig TE, Vose JM, Luigi Zinzani P, et al. An international phase II trial of single-agent lenalidomide for relapsed or refractory aggressive B-cell non-Hodgkin’s lymphoma. Ann Oncol. 2011 Jan 12. [Epub ahead of print].
Salles G, Duell J, González Barca E, Tournilhac O, Jurczak W, Liberati AM, et al. Tafasitamab plus lenalidomide in relapsed or refractory diffuse large B-cell lymphoma (L-MIND): a multicentre, prospective, single-arm, phase 2 study. Lancet Oncol. 2020 Jul. 21 (7):978-988. [QxMD MEDLINE Link]. [Full Text].
FDA approves selinexor for relapsed/refractory diffuse large B-cell lymphoma. U.S. Food & Drug Administration. Available at https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-selinexor-relapsedrefractory-diffuse-large-b-cell-lymphoma. June 22, 2020; Accessed: June 30, 2020.
Jia B, Shi Y, Kang S, Yang S, Hu S, Li Y, et al. Addition of rituximab is not associated with survival benefit compared with CHOP alone for patients with stage I diffuse large B-cell lymphoma. Chin J Cancer Res. 2015 Oct. 27 (5):516-23. [QxMD MEDLINE Link].