Submitted January 11, 2007
Accepted February 2, 2007
How I treat patients with diffuse large B-Cell lymphoma
James Olen Armitage*
Section of Oncology/Hematology, University of Nebraska Medical Center, Omaha, NE, United States
* Corresponding author; email: joarmita{at}unmc.edu.
The disease we now call diffuse large B-cell lymphoma has gone by many names in the past. These have included reticulum cell sarcoma (1), diffuse histiocytic lymphoma (2), and, more recently, diffuse mixed lymphoma, diffuse large cell lymphoma, or immunoblastic lymphoma--terms from the Working Formulation (3). Early studies of therapy for patients with diffuse large B-cell lymphoma contained some patients with aggressive T-cell lymphoma as these were lumped together in the Working Formulation and some older classifications. The correct diagnosis today is diffuse large B-cell lymphoma as utilized in the WHO classification (4). (Table 1) However, we know that this is still a heterogenous group that includes lymphomas with a wide variety of morphological appearances (Table 2), protein expression patterns, and gene expression patterns. For example, patients with diffuse large B-cell lymphoma can be divided into at least three clinically relevant groups using gene expression profiling (5-7). These include the germinal center type, the activated B-cell type and mediastinal large B-cell lymphoma (Table 3). A few patients will not be easily classified in these catagories. (8) Mediastinal large B-cell lymphoma represents less than ten percent of all large B-cell lymphomas, occurs primarily in young women, and always presents with a mediastinal mass. The gene expression profile is similar to that seen in classical Hodgkin's disease. (7, 9) The other two types of diffuse large B-cell lymphoma, and those not easily classified, have a median age at presentation in the sixties, a male predominance, and can present at essentially any site in the body.(8) They will be the major focus of this paper.
