Diffuse large B-cell lymphoma (DLBCL) represents the most prevalent aggressive form of non-Hodgkin lymphoma. Originating from the germinal center, DLBCL is recognized as a diverse group of diseases. These diseases exhibit varied patient outcomes and are distinguished by clinical features, cell of origin (COO), molecular characteristics, and frequently recurring mutations. Accurate Dlbcl Diagnosis is crucial for effective management and treatment strategies.
The diagnosis of DLBCL ideally commences with an excisional biopsy of a suspicious lymph node. Histopathological examination reveals sheets of large cells that disrupt the typical follicular architecture. These cells demonstrate positive staining for pan-B-cell antigens, notably CD20 and CD79a. Immunohistochemical staining is employed to determine the COO of DLBCL. Furthermore, molecular features, such as double-hit or triple-hit lymphoma, are identified through fluorescent in situ hybridization (FISH) analysis. While commercial tests exist for frequently recurring mutations, their routine use in guiding initial treatment decisions is not yet standard practice.
Clinical prognostic systems, including the rituximab International Prognostic Index, age-adjusted IPI, and NCCN-IPI, are utilized for risk stratification in DLBCL patients based on clinical factors. However, it’s important to note that this risk stratification does not currently alter the initial treatment approach. Notably, patients with non-germinal center B-cell (GCB)-like DLBCL, encompassing activated B-cell like and unclassifiable subtypes, exhibit a less favorable response to initial chemoimmunotherapy (CI) compared to those with GCB-like DLBCL. Moreover, individuals with c-MYC-altered DLBCL, particularly when combined with translocations in BCL2 and/or BCL6 (especially with immunoglobulin MYC translocation partners), often show poor responses to initial CI and subsequent salvage autologous stem cell transplant in cases of relapse.
Understanding the nuances of dlbcl diagnosis, including COO and molecular features, is increasingly important for tailoring treatment strategies. Future therapeutic approaches are likely to focus on differential treatment strategies based on these diagnostic classifications, both in the upfront setting and at relapse.
