Risk-Adapted Therapy for Patients With Untreated Low-Intermediate Risk, High-Intermediate Risk, or High Risk Diffuse Large B-Cell Lymphoma

About 60 percent of patients with diffuse large B-cell lymphoma (DLBCL) can be cured with a chemotherapy regimen called R-CHOP-21 (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone, given once every 3 weeks for 18 weeks). However, some patients may not be cured with this regimen.

A prior study has shown that giving this latter group of patients a different chemotherapy regimen after 4 cycles of R-CHOP increased the chance of a cure. This approach is called “risk-adapted therapy,” because it is given to patients with certain risk factors that indicate they have a higher risk of not being cured by R-CHOP-21 alone. The second regimen included a combination of chemotherapy drugs called ICE (ifosfamide, carboplatin, and etoposide), periodic PET scans, and for some patients, a stem cell transplant.

In the current study, researchers believe that they can further improve on the results of the last study of risk-adapted therapy by varying the drug combinations used in risk-adapted therapy and by altering the timing and types of PET scans used to monitor treatment response. Some patients will also receive high-dose chemoradiation therapy and a stem cell transplant.