From the Guidelines
Low B-cell lymphoma and large B-cell lymphoma are two distinct types of non-Hodgkin lymphoma with important differences in characteristics and treatment approaches, with low B-cell lymphoma being often incurable but manageable as a chronic disease, and large B-cell lymphoma being aggressive but potentially curable with immediate intensive therapy. The main difference between low B-cell lymphoma and large B-cell lymphoma lies in their growth rates and treatment outcomes. Low B-cell lymphoma, also called low-grade or indolent B-cell lymphoma, grows slowly and includes subtypes like follicular lymphoma, marginal zone lymphoma, and small lymphocytic lymphoma 1. These typically present with painless, enlarged lymph nodes, fatigue, and sometimes night sweats or weight loss. Treatment may include watchful waiting for asymptomatic patients, rituximab (anti-CD20 antibody) alone or with chemotherapy like bendamustine or CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone), and maintenance rituximab after initial treatment. In contrast, large B-cell lymphoma, particularly diffuse large B-cell lymphoma (DLBCL), is aggressive with rapidly growing tumors, and presents with quickly enlarging lymph nodes, B symptoms (fever, night sweats, weight loss), and sometimes organ dysfunction 1. Standard treatment is R-CHOP (rituximab plus CHOP) given every 21 days for 6 cycles, with more intensive regimens for high-risk disease. Some key points to consider when treating these conditions include:
- Histologic transformation of follicular lymphoma to DLBCL is generally associated with a poor clinical outcome, but recent studies have reported improved survival in a subset of patients 1.
- Small molecule inhibitors targeting the B-cell receptor pathway have demonstrated promising activity for the treatment of relapsed/refractory follicular lymphoma 1.
- CAR T-cell therapy has emerged as a novel treatment option for relapsed/refractory DLBCL and transformed follicular lymphoma 1. The treatment approach should prioritize the most recent and highest quality evidence, with a focus on improving morbidity, mortality, and quality of life outcomes.
From the Research
Low B Cell Lymphoma vs Large B Cell Lymphoma
- Low B cell lymphoma, such as follicular lymphoma, is often treated with rituximab, a monoclonal antibody that targets the CD20 protein on B cells 2.
- In contrast, large B cell lymphoma, such as diffuse large B-cell lymphoma (DLBCL), is typically treated with a combination of chemotherapy and rituximab, known as R-CHOP 3, 4.
- The R-CHOP regimen has been shown to be effective in treating DLBCL, with a cure rate of approximately 70% 4.
- However, the optimal treatment approach for low B cell lymphoma is still being studied, with some research suggesting that rituximab monotherapy may be sufficient for patients with asymptomatic, advanced-stage disease 2, 5.
- Quality of life is an important consideration in the treatment of both low and large B cell lymphoma, with rituximab treatment showing significant improvement in quality of life compared to watchful waiting in patients with advanced-stage, asymptomatic follicular lymphoma 5.
Treatment Approaches
- R-CHOP regimen: a combination of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone, commonly used to treat DLBCL 3, 4.
- Rituximab monotherapy: used to treat low B cell lymphoma, such as follicular lymphoma, in patients with asymptomatic, advanced-stage disease 2, 5.
- Watchful waiting: a treatment approach where patients with asymptomatic, advanced-stage follicular lymphoma are monitored regularly without receiving immediate treatment 2, 5.
Outcomes
- Progression-free survival: a measure of the length of time during and after treatment that a patient lives with the disease but it does not get worse 6.
- Overall survival: a measure of the length of time from either the date of diagnosis or the start of treatment that patients are still alive 3, 4.
- Quality of life: an important consideration in the treatment of both low and large B cell lymphoma, with rituximab treatment showing significant improvement in quality of life compared to watchful waiting in patients with advanced-stage, asymptomatic follicular lymphoma 5.