Diffuse large B-cell lymphoma (DLBCL) treatment and side effects

You might also want to read our general information about how blood cancer treatment is planned and managing your treatment. We also have some important information on staying safe if you’ve got blood cancer, covering things like risk of infection and vaccinations.

Treatment for DLBCL usually involves a combination of different treatment types.

There are several treatment options that doctors will consider for high-grade NHL, depending on your particular circumstances. These include:

• chemotherapy: drugs that stop cancer cells growing and dividing
• radiotherapy: this uses X-rays to kill cancer cells in a specific area of the body
• targeted (biological) therapies: these support the body to attack cancer cells or control their growth
• steroids: drugs that are very effective in killing lymphoma cells, often used alongside chemotherapy and targeted therapies
• growth factor injections (G-CSF): injections that encourage your bone marrow to make white blood cells to help prevent infection.

The treatment that’s best for you will largely depend on your symptoms, as well as the stage of the lymphoma. Your healthcare team will always discuss your treatment options with you, explain why a certain treatment has been recommended and take your wishes into account when planning your treatment.

Some treatments for DLBCL may affect your fertility (your ability to get pregnant or father a child in future). If this is a concern for you, speak to your healthcare team about the options available before you start your treatment.

We have general information about treatment types for blood cancer.

Your first treatment may involve chemotherapy, radiotherapy, a targeted therapy, or a combination of these. The most common combination of drugs used to treat DLBCL is called R-CHOP.

R-CHOP includes the following drugs:

• rituximab: one of a group of drugs called monoclonal antibodies, a type of targeted therapy
• cyclophosphamide: a chemotherapy (anti-cancer) drug
• hydroxydaunorubicin, (also called Doxorubicin): a chemotherapy drug
• vincristine (which used to be called Oncovin): a chemotherapy drug
• prednisone: a steroid tablet.

If you’re not fit enough to have the full R-CHOP treatment, you might be given a lower dose which is safer but still known to be effective. You’ll have this treatment as an outpatient, so you won’t need to stay overnight in hospital. It’s given through a drip into your vein, called an infusion.

The stage of your condition will affect the first treatment you have.

• Stage I: Because DLBCL tends to be fast-growing, only a small number of people are at stage I when they start their treatment. If you are at stage I, you’ll usually receive three courses of R-CHOP chemotherapy, along with radiotherapy to the affected area.
• Stages, II, III and IV: Most people with DLBCL will fall into this group. Your treatment will usually involve six courses of R-CHOP chemotherapy.

Once you’ve finished your treatment, you’ll have a PET/CT scan to see if all the lymphoma cells have been destroyed. After this scan, your doctor may talk to you about ‘complete’ or ‘partial’ remission.

• Complete remission – when there are no lymphoma cells in your body. You may hear your specialist talk about a complete metabolic response.
• Partial remission – when the amount of lymphoma in your body has gone down by more than half, but there are still some lymphoma cells in your body. You might need some extra treatment to target these cells.