NCCN Guidelines for Patients Diffuse Large B-Cell Lymphoma

1 P. NC our le CN on ase .o lin co rg /p e s mp at u le NCCN ie rv t nt e s/ ey Guidelines su at FOR Patients . 2020 rv ey Diffuse Large B-Cell Lymphoma NON-HODGKIN'S Lymphoma SERIES. Presented with support from: Available online at . Diffuse Large B-Cell Lymphoma It's easy to get lost in the cancer world Let NCCN Guidelines for Patients . be your guide 9 Step-by-step guides to the cancer care options likely to have the best results 9 Based on treatment Guidelines used by health care providers worldwide 9 Designed to help you discuss cancer treatment with your doctors NCCN Guidelines for Patients : Diffuse Large B-Cell Lymphoma , 2020 1. About NCCN Guidelines for Patients are developed by the national Comprehensive Cancer Network (NCCN ). NCCN Clinical Practice NCCN Guidelines NCCN Guidelines in Oncology . for Patients (NCCN Guidelines ). An alliance of leading Developed by doctors from Present information from the cancer centers across the NCCN cancer centers using NCCN Guidelines in an easy- United States devoted to the latest research and years to-learn format patient care, research, and of experience education For people with cancer and For providers of cancer care those who support them all over the world Cancer centers Explain the cancer care that are part of NCCN: Expert recommendations for options likely to have the cancer screening, diagnosis, best results and treatment Free online at Free online at and supported by funding from NCCN Foundation.

2 These NCCN Guidelines for Patients are based on the NCCN Guidelines for B-Cell Lymphomas Version (August 13, 2020). 2020 national Comprehensive Cancer Network, Inc. All rights reserved. NCCN Foundation seeks to support the millions of Patients and their families NCCN Guidelines for Patients and illustrations herein may not be reproduced in affected by a cancer diagnosis by funding and distributing NCCN Guidelines for any form for any purpose without the express written permission of NCCN. No Patients . NCCN Foundation is also committed to advancing cancer treatment one, including doctors or Patients , may use the NCCN Guidelines for Patients for by funding the nation's promising doctors at the center of innovation in cancer any commercial purpose and may not claim, represent, or imply that the NCCN research. For more details and the full library of patient and caregiver resources, Guidelines for Patients that have been modified in any manner are derived visit from, based on, related to, or arise out of the NCCN Guidelines for Patients .

3 The NCCN Guidelines are a work in progress that may be redefined as often national Comprehensive Cancer Network (NCCN) / NCCN Foundation as new significant data become available. NCCN makes no warranties of any 3025 Chemical Road, Suite 100. kind whatsoever regarding its content, use, or application and disclaims any Plymouth Meeting, PA 19462. responsibility for its application or use in any way. NCCN Guidelines for Patients : Diffuse Large B-Cell Lymphoma , 2020 2. Supporters Endorsed by The Leukemia & Lymphoma Society The Leukemia & Lymphoma Society (LLS) is dedicated to developing better outcomes for blood cancer Patients and their families through research, education, support and advocacy and is happy to have this comprehensive resource available to Patients . To make a gift or learn more, please visit or e-mail NCCN Guidelines for Patients : Diffuse Large B-Cell Lymphoma , 2020 3. NCCN Guidelines for Patients : Diffuse Large B-Cell Lymphoma , 2020 4.

4 Diffuse Large B-Cell Lymphoma Contents 6 DLBCL basics 12 Tests for DLBCL. 17 Before treatment starts 29 Treatment options 40 Making treatment decisions 48 Words to know 51 NCCN Contributors 52 NCCN Cancer Centers 54 Index NCCN Guidelines for Patients : Diffuse Large B-Cell Lymphoma , 2020 5. 1. DLBCL basics 7 The lymph system 7 Types of Lymphoma 9 Subtypes of DLBCL. 9 Types of treatment 11 Review NCCN Guidelines for Patients : Diffuse Large B-Cell Lymphoma , 2020 6. 1 DLBCL basics The lymph system | Types of Lymphoma Diffuse Large B-Cell Lymphoma (DLBCL) Lymph tissue is a type of cancer called non-Hodgkin Lymph tissue has high numbers of white blood Lymphoma . It is a fast-growing cancer, cells called lymphocytes. There are small but with the right treatment, it can be clumps of lymph tissue in your gut, thyroid, well controlled. breasts, lungs, eyes, and skin. You also have larger masses of lymph tissue in the: Spleen The lymph system Tonsils Thymus Lymphoma is a cancer of the lymph (or lymphatic) system.

5 The lymph system is a Lymph nodes network of fluid and tissues in your body. It supports the cardiovascular system by As lymph travels through lymph vessels, it transporting fluids to the bloodstream. It is also passes through hundreds of structures called a major part of your body's disease-fighting lymph nodes. Lymph nodes filter out germs (immune) system. from lymph. Some areas of the body have more lymph nodes than others. The highest numbers of lymph nodes are found in the: Lymph and lymph vessels Lymph is a fluid within a super highway of Neck (cervical lymph nodes). ducts throughout the body. These ducts are called lymph (or lymphatic) vessels. Lymph Groin (inguinal lymph nodes). vessels carry lymph away from body tissue and Armpits (axillary lymph nodes). release it into the bloodstream. Lymph is formed from tissue (or interstitial). fluid. Tissue fluid fills the spaces between cells in body tissue. It is made from the part Types of Lymphoma of the blood called plasma.

6 When tissue fluid Lymphoma forms from cells called increases, some of it drains into lymph vessels lymphocytes. They are part of the immune and becomes lymph. system and help to fight disease. The three types of lymphocytes are B cells, T cells, and There is fatty lymph called chyle. After you eat, natural killer cells. your stomach turns food into a liquid. Then, the liquid moves into your small intestine. Within There are two main types of lymphomas: your small intestine, fat and some vitamins drain into lymph vessels and form chyle, Chyle Hodgkin Lymphoma travels in lymph vessels to the bloodstream. Non-Hodgkin Lymphoma Doctors can tell the type of Lymphoma by looking at the cancer cells under a microscope. NCCN Guidelines for Patients : Diffuse Large B-Cell Lymphoma , 2020 7. 1 DLBCL basics Types of Lymphoma Hodgkin Lymphoma is a cancer of B cells called the tests of cells that are used to confirm Reed-Sternberg cells. These cells are very (diagnose) DLBCL.

7 Large . Unlike a normal cell, they may have an owl-eye look from having two nuclei. DLBCL is named for how it looks under a microsope. It has a wide ( Diffuse ) pattern of Non-Hodgkin Lymphoma is the more common growth. The cancer cells grow throughout type. It is a group of more than 90 cancers. tissue rather than in clusters. It is also named These cancers do not have Reed-Sternberg after the Large size of the cancer cells. cells. They are cancers of B cells, T cells, or natural killer cells. DLBCL is a fast-growing cancer. The cancer cells often build up in lymph tissue. Lymph nodes with cancer may become so Large that Diffuse Large B-Cell Lymphoma they can be easily felt. The cancer cells often Diffuse Large B-Cell Lymphoma (DLBCL) is grow fast compared to other lymphomas. The a non-Hodgkin Lymphoma . It is a cancer of cancer cells can involve body parts outside the B cells. B cells transform through many stages lymph system. to become cells that are able to fight disease.

8 DLBCL is a cancer of mature B cells from the lymph system. Read Part 2 to learn about Lymphoma Lymphoma is a cancer of the lymph (or lymphatic). system. This system transports a fluid called lymph to the bloodstream. It also helps the immune system fight disease. Lymph vessels and nodes are depicted in green in the picture. NCCN Guidelines for Patients : Diffuse Large B-Cell Lymphoma , 2020 8. 1 DLBCL basics Subtypes of DLBCL | Types of treatment Subtypes of DLBCL Primary cutaneous marginal zone Lymphoma (PCMZL). There are many subtypes of DLBCL. The Primary cutaneous follicle center treatment options in this book apply to these Lymphoma (PCFCL). types: Primary DLBCL of the central nervous ALK-positive DLBCL system DLBCL with follicular Lymphoma Primary mediastinal Large B-Cell Lymphoma (PMBL). DLBCL with gastric MALT Lymphoma DLBCL with nongastric MALT Lymphoma DLBCL, not otherwise specified (NOS).. Types of treatment DLBCL associated with chronic inflammation This section briefly describes treatments for DLBCL.

9 Not everyone receives the same DLBCL with IRF4/MUM1 rearrangement treatment. Your doctor will tailor treatment EBV-positive DLBCL, NOS to you based on tests in Part 2 and Part 3. Treatment options based on the extent of Intravascular Large B-Cell Lymphoma cancer and other factors are listed in Part 4. T-cell-/histiocyte-rich Large B-Cell Lymphoma Clinical trial One treatment choice may be a clinical trial. Treatment options in this book may also apply Joining a clinical trial is strongly supported by to follicular Lymphoma grade 3. Grade 3 is the NCCN. NCCN believes that you will receive the highest grade. It is divided into grade 3A and best management if treated in a clinical trial. grade 3B. A clinical trial is a type of research that studies This book does not include information on: a promising test or treatment in people. It gives people access to health care that otherwise DLBCL arising from chronic lymphocytic couldn't usually be received.

10 Ask your treatment leukemia (Richter's transformation). team if there is an open clinical trial that you Grey zone Lymphoma can join. High-grade B-Cell Lymphoma with translocations of MYC and either or both Antibody treatment BCL2 and BCL6 Antibodies are proteins of the immune system. They help your body fight germs and other HIV-positive DLBCL. threats. Monoclonal antibodies can be made in Primary cutaneous DLBCL, leg type a lab to treat certain types of cancer. NCCN Guidelines for Patients : Diffuse Large B-Cell Lymphoma , 2020 9. 1 DLBCL basics Types of treatment There are two antibody treatments for DLBCL. Antimetabolites include gemcitabine, methotrexate, and cytarabine. Rituximab Plant alkaloids include vincristine and Tafasitamab-cxix etoposide. Rituximab attaches to a surface protein on cells called CD20, and tafasitamab-cxix attaches to Corticosteroids CD19. They mark the cells so that your immune Corticosteroids are a class of drugs that are system can find and destroy them.