Standard therapy for all patients with diffuse large B-cell lymphoma (DLBCL), regardless of disease stage or prognosis, includes rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Acceptable management includes chemotherapy alone or a shorter course of chemotherapy with involved-field radiation in early stage disease. The lymphomas are of B-cell or T-cell phenotype. DLBCL is the most common form of lymphoma and, together with the less common T-cell phenotype, represents 30% of all lymphomas. Most patients with DLBCL present with advanced (stage III and IV) disease and have symptoms including fever, night sweats, and weight loss (“B” symptoms). Disease progression is rapid without therapy. The revised International Prognostic Index (r-IPI) score was developed to assist in determining prognosis before therapy. The r-IPI score is based on the patient's age, serum lactate dehydrogenase level, number of extranodal sites, disease stage, and performance status. Because this patient has limited disease and a low r-IPI score, standard R-CHOP chemotherapy should result in a durable complete remission. Expected cure rates range from less than 20% for patients with advanced disease and a high r-IPI score to greater than 80% for those with localized disease and a low r-IPI score. Studies are ongoing regarding the effectiveness of more aggressive initial therapy for patients with advanced disease associated with high r-IPI scores, such as using rituximab plus hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (R-hyper-CVAD) and adding novel agents, including immunomodulators such as lenalidomide. However, standard R-CHOP chemotherapy is appropriate for this patient at this time.

Allogeneic hematopoietic stem cell transplantation (HSCT) remains investigational as salvage therapy for patients with DLBCL due to the high risk of morbidity.

Autologous HSCT is reserved as salvage therapy for patients who have chemotherapy-sensitive relapsed disease associated with a greater than 1-year disease-free interval from the start of initial therapy. Early relapse patients have poor outcomes after autologous HSPCT and should be considered for clinical trials.

Involved-field radiation therapy is indicated for patients with bulky disease. This patient has no evidence of bulky disease at this time.