Abstract

MULLER, Aixa; TORRES, María A; SOYANO, Aixa Elena  and  SOYANO, Andrés. Tratamiento del linfoma difuso de células B grandes (LDCBG) en estadios avanzados. Gac Méd Caracas. [online]. 2017, vol.125, n.4, pp.276-298. ISSN 0367-4762.

The Diffuse Large B-Cell Lymphoma (DLBCL), the most common form of Non-Hodgkin Lymphoma, is classified in three types: 1. Germinal Center-Like B Cell (GCB), 2. Activated B Cell-like (ABC), 3. Mediastinal. They show rearrangement of genes BCL-6, BCL-2 and c-MYC (with worse prognosis). The internationally accepted first-line treatment is R-CHOP-21 (6 cycles), with re-staging after 2-4 cycles of R-CHOP-21. R-CHOP-14 and DA-EPOCH may also be used. We describe second-line options for relapses, for patients not candidates for high doses of chemotherapy (e. g., Bendamustine ± Rituximab or Brentuximab Vedotin), novel treatments for the GCB and ABC subtypes. The molecular prognosis and the use of agents such as Bortezomib, a proteosome inhibitor with greater specificity and lower toxicity are reviewed; these provide an alternative for patients fragile to R-CHOP, refractory or relapsing. We also describe options for patients with poor ventricular function, > 80 years of age with comorbidities, CNS disease, and varieties such as Primary Mediastinal, Gray Zone Lymphoma, Double Hit Lymphoma and Primary Testicular Lymphoma.

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