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Treatment Strategies for Diffuse Large B Cell Lymphoma

Catherine Thieblemont, MD, and Christian Gisselbrecht, MD

Diffuse large B cell lymphoma (DLBCL) is the most common form of adult non-Hodgkin lymphoma (NHL), accounting for 25–30% of NHL cases [1]. The incidence of DLBCL increases with advancing age, such that the disease represents >40% of NHL cases among elderly patients aged >75 years [2,3]. Although DLBCL is a well-defined entity and has been recognized since the first classifications of NHL [4,5], the complexity and heterogeneity of the disease has only recently been demonstrated (over the past 10 years), firstly by the most recent World Health Organization (WHO) classification, which includes no less than 15 different subentities [6], and secondly by the gene-expression profiling analyses that have divided the disease into at least two molecular subgroups (germinal center B-cell-like [GCB] and activated B-cell-like [ABC] DLBCL) [7]. The clinical impact of these histological subentities is important for clinicians when considering that besides the typical DLBCL, entities such as primary mediastinal large B cell lymphoma, or DLBCL with features intermediate between DLBCL and Burkitt lymphoma, may affect the choice of treatment.

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