TY - CHAP M1 - Book, Section TI - Aggressive B-Cell Lymphomas A1 - Steiner, Raphael A1 - Westin, Jason R. A1 - Konoplev, Sergej N. A1 - Fayad, Luis E. A1 - Medeiros, L. Jeffrey A2 - Kantarjian, Hagop M. A2 - Wolff, Robert A. A2 - Rieber, Alyssa G. PY - 2022 T2 - The MD Anderson Manual of Medical Oncology, 4e AB - KEY CONCEPTSEvaluation of pretreatment prognostic factors of diffuse large B-cell lymphoma (DLBCL) includes scores such as the International Prognostic Index (IPI); cell-of-origin (germinal center B-cell subtype [GCB] and activated B-cell [ABC] subtype); genetic profiling (such as fluorescence in situ hybridization studies [FISH] for MYC rearrangement, if MYC rearrangement is detected, additional FISH studies for BCL2 and BCL6 rearrangements should be performed); and immunophenotypic studies (such as MYC, BCL2, and BCL6 expression).The baseline workup of aggressive B-cell lymphoma should not omit testing for hepatitis B and HIV, echocardiogram, or multigated acquisition scan (if planned therapy with anthracycline), and fertility counseling for eligible patients.Besides a clinical trial, the standard-of-care frontline therapy of DLBCL not otherwise specified is still rituximab cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). However, many studies are ongoing to outperform this combination.The treatment plan of aggressive B-cell lymphoma should evaluate the potential need for central nervous system (CNS) prophylaxis for patients presenting with the following risk factors: elevated CNS-IPI (age >60 years, Eastern Cooperative Oncology Group [ECOG] Performance Status ≥2, extranodal disease >1 site, stage III/IV, elevated lactate dehydrogenase, kidney/adrenal involvement); extranodal disease with testicular, uterine, breast, epidural, skin involvement); aggressive B-cell lymphoma subtypes (Burkitt lymphoma, double/triple-hit lymphoma/high-grade B-cell lymphoma, double-expressor lymphomas, HIV-associated lymphoma, DLBCL with ABC subtype, intravascular DLBCL, CD5+ DLBCL, IgM-secreting DLBCL).The baseline workup of a suspected primary CNS lymphoma should include magnetic resonance imaging (MRI) of the brain and biopsy of the lesion, search for additional disease sites, such as testicular ultrasound for men >60 years old, full ophthalmologic examination including slit-lamp eye examination, spine MRI, positron emission tomography/computed tomography (PET/CT) scan, and bone marrow biopsy.The optimal frontline therapy of Burkitt lymphoma has yet to be defined in a prospective randomized trial, but R-CHOP is not an adequate therapy. If a patient cannot be enrolled in a clinical trial, aggressive combination chemotherapy such as R-Hyper-CVAD/MA, R-CODOX-M/IVAC, or DA-EPOCH-R with adequate CNS prophylaxis is recommended. SN - PB - McGraw Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accessmedicine.mhmedical.com/content.aspx?aid=1190832953 ER -