title: Managing early failures with R-CHOP in patients with diffuse large B-cell lymphoma.
abstract: Patients with refractory or relapsing diffuse large B-cell lymphoma (DLBCL) represent a major challenge for physicians, and the tools necessary to manage these situations remain limited and better options are needed. Despite the overall improvement in the outcome of patients with DLBCL since the introduction of front-line immunochemotherapy (R-CHOP), 20% of patients are primarily refractory or experience short-term relapse and have an extremely poor prognosis. Areas covered: This article reviews the current landscape of refractory/relapsed DLBCL management solutions, including chemotherapy and targeted therapies, with a special focus on primary refractory patients. We performed a literature search using PUBMED to find recent major publications establishing how to best determine the optimal treatment for these patients with regard to recent advances and emerging therapies. Expert commentary: High-dose chemotherapy (HDC) followed by autologous hematopoietic stem cell transplantation (ASCT) can provide durable disease control in this situation regardless of the timing of the relapse and represents the standard of care after R-CHOP failure for 'fit' patients less than 70 years of age.
authors: a Department of Hematology, Centre Henri Becquerel , Université de Rouen, IRIB , Rouen , France.
authors: Vincent
authors: V
authors: Camus
authors: a Department of Hematology, Centre Henri Becquerel , Université de Rouen, IRIB , Rouen , France.
authors: Hervé
authors: H
authors: Tilly
mesh_terms: D000367:Age Factors; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D019468:Disease Management; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D019008:Drug Resistance, Neoplasm; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D012008:Recurrence; D019233:Retreatment; D000069283:Rituximab; D016879:Salvage Therapy; D014182:Transplantation, Autologous; D017211:Treatment Failure; D016896:Treatment Outcome; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: Diffuse large B-cell lymphoma; autologous hematopoietic cell transplantation; rituximab; salvage chemotherapy; targeted therapies