- Clinically and biologically heterogenous groups
- Expanded list of disease included in WHO 2008 Classification for DLBCL serves i
- delineating a more homogeneous group of DLBCL for clinical trials and
- facilitating the study of rare variants, which may require specialized approaches
- Most DLBCL that do not have specific clinical and pathological variants have been included under DLBCL, NOS in WHO 2008 Classification
- Gene Expression Profile has identified two principal molecular subtypes of DLBCL with distinct genetic alteration, molecular signaling, and clinical outcomes
- Germinal Center B-Cell-Type (GCB)
- Activated B-Cell-Type
- Yet, is not used in routine clinical practice due to difficulty in reproducibility
- WHO 2008 Classification also emphasizes on LOCATION and other clinical features in the diagnosis of certain entities. eg.
- Primary Mediasternal Large B-Cell Lymphoma (PMBL)
- Primary CNC Large B-Cell Lymphoma (Primary CNS DLBCL)
- Variants of DLBCL in 2008 WHO Classification Lancet 2013
Variants of diffuse large B-cell lymphoma in the 2008 WHO classification Centroblastic Immunoblastic Anaplastic Plasmablastic T-cellrich Anaplastic lymphoma kinase-positive CD5-positive Germinal centre B cell Non-germinal centre B cell PrimaryCNS Primary cutaneous, leg-type Mediastinal Intravascular Primaryeffusion Epstein-Barr virus-positive in elderly people With chronic inflammation Lymphomatoidgranulomatosis In human herpes virus-8-associated Castleman’s disease
- Treatment: Lancet 2013
- CHOP with Radiation (Pre-rituximab era)
- CHOP - R with Radiation (Post-rituximab era).
- Rituximab improved 3 yr overall survival (93 % vs. 84 %)
- 30 - 40 % relapse after first-line chemotherapy requiring salvage therapy
- Plasmablastic DLBCL is a histological variant seen in HIV patients
- Involves head and neck
- Usually does not express CD 20, hence, does not benefit from Rituximab
71 yo M is seen for lf hip pain. skin thickening is noted. ddx; - bendamustine–Rituxan.
- r chop
- R–EPOCH
- R–ice chemotherapy
Granix
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