Diffuse large B-cell treatment aims and types

For most people, the aim of treatment for DLBCL is to cure it. You will be offered the best treatment for you, based on your personal circumstances, your stage and your general health.

Your hospital team will explain what the treatment options are, and what they will involve. They should also answer your questions and listen to your wishes.

A few people may not be well enough to have standard treatments for DLBCL. If this is the case for you, you will be offered a gentler (less intensive) treatment. The aim will be to keep the DLBCL under control and manage the symptoms.

If you need help with discussions about your treatment, our Support Service can help. Call us free on 0808 2080 888 or email [email protected].

Different types of treatment for DLBCL are used in different situations. We also have information about specific treatments and when they might be used.

Chemoimmunotherapy is the first treatment for most people with DLBCL.

• Chemotherapy drugs work by stopping lymphoma cells dividing and growing. Chemotherapy drugs for DLBCL include cyclophosphamide, doxorubicin and vincristine (Oncovin).
• Immunotherapy drugs work by binding to lymphoma cells and helping your immune system to find and kill them. Examples of immunotherapy drugs for DLBCL are rituximab and polatuzumab. These are targeted therapies. They are directed specifically at abnormal cells so the damage to healthy cells is limited.

For people who don’t go into long-term remission after two previous treatments, bispecific antibodies are an option.

Bispecific antibodies are designed to attach to both lymphoma cells and healthy immune cells. They help the immune system destroy the lymphoma.

These are also targeted therapies which limit the damage to healthy cells.

Steroids help to kill lymphoma cells and work together with other drugs. They also reduce swelling (inflammation). The steroid prednisolone is usually given as part of a combination of drugs for DLBCL.

Radiotherapy uses high energy rays to kill cancer cells in a specific area. If you have early stage (stage 1 or 2) lymphoma or bulky disease (a large swelling), you are likely to have radiotherapy to the area of the body affected by the lymphoma. If you need radiotherapy, you will have it after chemoimmunotherapy.

Radiotherapy can also relieve pain caused by swollen lymph nodes (glands).

If the DLBCL comes back (relapses) after your first treatment, you may be offered a stem cell transplant. This is usually an autologous stem cell transplant – one using healthy cells from your own body. This is an option if further treatment with chemoimmunotherapy works well, and your overall health is good.

We have more information about stem cell transplants.

If the DLBCL relapses, you may be offered CAR T-cell therapy. This is a newer treatment where T cells are removed from your body and genetically engineered in a lab to make them more effective at killing cancer cells. They are then returned to your blood.

CAR T-cell therapy is an intensive treatment that’s not suitable for everybody. Your team will consider carefully whether you are fit enough to have it.

We have more information about CAR T-cell therapy.

Palliative care aims to manage symptoms, reduce pain and generally improve quality of life. It is designed to help you live as well as possible with your diagnosis.

Palliative care is not the same as end-of-life care – you may have it at any stage after diagnosis, even alongside other treatments. It may include social and psychological support as well as medication.

You may choose not have treatment to cure the DLBCL, and that is your right.

Talk to your hospital team if you are considering this. Palliative care can ease your symptoms if you decide against treatment to cure DLBCL.

If you want to talk through treatment decisions and how to explain them to the people close to you, call our Support Service nurses on 0808 2080 888.

> Treatment for diffuse large B-cell lymphoma (DLBCL)