Diffuse large B-cell lymphoma (DLBCL) grows fast, so you usually start treatment right away. The type you get depends on your overall health and stage of your cancer. For DLBCL, most people have chemotherapy (chemo) and immunotherapy using several cancer medicines. Or they might have chemo plus radiation.
It’s normal to worry about having chemo. It helps to know what side effects to expect and the best way to handle them. Also, keep in mind that many people with DLBCL have no signs of cancer after treatment.
R-CHOP
This is the most common treatment for DLBCL. It’s made of three cancer medicines -- cyclophosphamide (Cytoxan), doxorubicin (Adriamycin), and vincristine (Oncovin) -- plus the steroid prednisone.
The “R” stands for a medicine called rituximab, an immunotherapy that specifically targets cancer cells.
Most chemo treatments use a combination of cancer medicines because each one attacks cancer in a different way.
Sometimes the medicines in R-CHOP need to change, especially if you’re older or have other health problems. For instance, doxorubicin can damage your heart. So if you have heart trouble, you may have a treatment called R-CEOP instead. The “E” stands for a medicine called etoposide (Etopophos).
Being pregnant could mean changes in your treatment, too. You and your doctor will choose a treatment that’s safe for both you and your baby.
What to expect. You get the first four R-CHOP medicines in an IV and take prednisone in pill form. You have this treatment about six times across a few months. If your cancer’s in the early stages, you may need less chemo. But it may be combined with radiation that directly targets the tumor.
Sometimes your doctor may inject chemo into the fluid around your spine. This is called intrathecal chemotherapy. No matter how it’s given, you only have R-CHOP every 3 weeks. This gives your body time to recover between treatments.
Side effects. R-CHOP causes side effects for most people. Some are medical emergencies:
Febrile neutropenia. This is a fever along with low levels of white blood cells called neutrophils. It can be life-threatening. If you’re getting chemo and have a temperature above 100.4 F, call your doctor right away.
Nausea and vomiting. You’re likely to have some after R-CHOP. You’ll get medicine before and after treatment to help ease it a bit.
Hypersensitivity reaction. This might happen after your first chemo treatment. It can cause, among other things:
- Pain
- Fever
- Itching
- Dizziness
Your doctor may give you certain medicines to make these less severe.
Tumor lysis syndrome. This happens when tumor cells die and release toxins into your blood. You might have nausea, vomiting, heart trouble, bloody pee, or seizures. You’re given medicine before treatment to help lower your chances of having these symptoms.
Other problems. Chemo can damage your heart or nerves or make it harder to have children. It can also raise your chance of having other types of cancer.
After treatment. Your doctor will watch you closely to see if your treatment worked. You’ll have a physical exam and imaging tests like PET or CT scans. If R-CHOP hasn’t worked, a clinical trial may be an option. This is a research study that tries to find the best treatment for a disease. It allows you try new medicines that aren’t on the market yet. Your doctor can tell you more.
When Cancer Comes Back
Sometimes, DLBCL goes away and then comes back. If this happens, your doctor will likely try another chemo treatment. If it works, you might have the option of having a stem cell transplant. This offers the best chance for a cure. But a stem cell transplant is really hard on your body. It can cause severe side effects and even death.
It’s hard emotionally, too. You need to spend weeks in a special room in the hospital so you don’t get an infection. And your chance of infection remains high even after you go home. Many people aren’t healthy enough for a stem cell transplant. Or it may not seem worth it.
When at least two previous treatments have failed, a treatment called CAR (chimeric antigen receptor) T-cell therapy is sometimes used in adults. It's a type of gene therapy, where a person’s own T cells are genetically modified in the lab, reproduced and then infused back into the patient to target the lymphoma cells.
The three approved for use are axicabtagene (Yescarta), lisocabtagene (Breyanzi), and tisagenlecleucel (Kymriah).
Other immunotherapy options your doctor may suggest are tafasitamab (Monjuvi) as well as loncastuximab tesirine-lpyl (Zynlonta) and polatuzumab vedotin-piiq (Polivy), which are man-made antibodies attached to a chemotherapy drug designed to attack the cancer cells themselves.
A targeted therapy option if your DLBCL is no longer responding to chemotherapy is selinexor (Xpovio).
Your doctor will consider the benefits and side effects of each treatment to find the best option for you.