ESMO E-Learning: DLBCL Clinical case - Adherence to the ESMO Clinical Practice Guidelines

Learning Objectives

  1. To describe current approach to diagnosis, staging and risk-assessment in patients with diffuse large B-cell lymphoma (DLBCL)
  2. To describe current treatment approaches in first-line, and relapsed/refractory DLBCL settings
  3. To understand attempts in the clinical studies to predict the outcome or increase the treatment efficacy in subsets of patients with DLBCL
Title Duration Content CME Points CME Test
DLBCL Clinical case - Adherence to the ESMO Clinical Practice Guidelines 37 min. 19 slides 1 Take Test
Umberto Vitolo
Umberto Vitolo
Read more

Diffuse large B-cell lymphoma (DLBCL) constitutes 30–58% of lymphoma series. The crude incidence in the European Union is 3–4/100 000/year and it increases with age. Diagnosis should be made on the basis of a surgical specimen/excisional lymph node or extranodal tissue biopsy providing enough material for formalin-fixed samples.
 
This presentation has been developed with the purpose of discussing the clinical perspective of recently revised ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with DLBCL. The guideline’s text covers chapters on diagnosis; staging and risk assessment; treatment recommendations for young low-risk patients without bulky disease; treatment recommendations for young low-intermediate-risk patients with bulky disease; treatment recommendations for young high and high-intermediate-risk patients; treatment recommendations for patients aged 60–80 years, and patients aged >80 years; CNS prophylaxis; clinical presentations of extranodal DLBCL which require special consideration; response evaluation; follow-up, and clinical recommendations for patients with relapsed and refractory DLBCL.
This E-learning module presents a patient case with a clinical scenario of high-risk DLBCL. The case involves issues about diagnosis, staging, treatment plan, final re-staging which confirmed a complete response in this case. The author further elaborates if there is a need for additional treatment after achieving the complete response and what could be the treatment options in such situation.
The case continues with the patient’s admission to the emergency department due to very fast relapse of the disease, with a question on the salvage treatment. After three courses of therapy, a partial response is recorded with improvement in the patient’s general condition. The collection of peripheral blood stem cells is conducted with the aim of high-dose therapy and autologous stem transplantation, but the rapid progression of the disease occurs again. In general, a very aggressive and short course of disease, but presented in the frame of very rich clinical scenario.
The author finishes the case with a discussion on studies that aim to address issues on predictive value of interim PET in DLBCL patients treated at the diagnosis with rituximab-CHOP, and the study of lenalidomide plus R-CHOP21 in the first-line treatment in elderly, high risk patients by questioning on safety and how to improve the treatment efficacy.   
Aiming to enhance experience with the ESMO guidelines material, we strongly recommend all medical professionals involved in the treatment of patients with DLBCL to refer to the full version of the guidelines text available in the supplement issue of Annals of Oncology, as well as the Guidelines section of this website.

Last update: 05 November 2013

The author has reported to be a member of the Advisory Board of Roche and to receive meetings lecture fees from Celgene, Takeda and Mundipharm.