From the Guidelines
For managing B symptoms in DLBCL patients on hospice, a multimodal approach is recommended, prioritizing comfort and quality of life over disease modification. The management of B symptoms, including fever, night sweats, and weight loss, is crucial in improving the quality of life for patients with diffuse large B-cell lymphoma (DLBCL) on hospice care.
Symptom Management Strategies
- For fever and mild discomfort, acetaminophen 650-1000mg every 6 hours can be used, supplemented with NSAIDs like ibuprofen 400-600mg every 6 hours if needed and not contraindicated 1.
- For night sweats, using moisture-wicking bedding and clothing, keeping the room cool, and considering low-dose antidepressants such as mirtazapine 7.5-15mg at bedtime can be beneficial, as it can also stimulate appetite.
- For weight loss and anorexia, dexamethasone 2-4mg daily or prednisone 10-20mg daily can be tried, which can simultaneously reduce inflammation driving B symptoms. Megestrol acetate 400-800mg daily can stimulate appetite but carries a thrombosis risk.
- Cannabinoids like dronabinol 2.5mg twice daily may help with appetite and nausea.
Palliative Radiation
For severe symptoms, low-dose palliative radiation (8Gy in 1 fraction or 20Gy in 5 fractions) can provide relief by reducing tumor burden, as noted in various studies on palliative care in oncology 1. These interventions target the inflammatory cytokines (IL-1, IL-6, TNF-alpha) produced by lymphoma cells that cause B symptoms.
Considerations
The choice of therapy should be individualized, considering the patient's performance status, comorbidities, and personal preferences. Geriatric assessment tools can be valuable in evaluating older or frail patients and choosing appropriate therapies 1. The introduction of novel therapeutic agents may offer additional options for managing B symptoms in the future.
Given the focus on palliative care in the hospice setting, the primary goal is to alleviate symptoms and improve the patient's quality of life, rather than pursuing curative treatments. Therefore, a comprehensive and multidisciplinary approach to symptom management is essential.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Palliative Therapies for Managing "B Symptoms" in DLBCL
Palliative therapies are crucial in managing "B symptoms" such as fever, night sweats, and weight loss in patients with diffuse large B-cell lymphoma (DLBCL) on hospice care. The following are some palliative therapies that can help manage these symptoms:
- Corticosteroids: Prephase with corticosteroids can be helpful in preventing adverse events and managing symptoms 2
- Supportive care: Rigorous supportive care, including granulocyte colony-stimulating factor prophylaxis and careful monitoring, can be important in preventing adverse events and managing symptoms 2
- Palliative chemotherapy: Palliative therapy, such as second-line outpatient chemotherapy, can be used to manage symptoms and improve quality of life in patients with relapsed or refractory DLBCL 3
- Symptom management: Management of specific symptoms such as pain, nausea, and fatigue can be achieved through various palliative therapies, including medications, radiation therapy, and other interventions
Considerations for Hospice Care
When considering palliative therapies for patients with DLBCL on hospice care, the following factors should be taken into account:
- Patient's overall health and prognosis: The patient's age, comorbidities, and overall health should be considered when selecting palliative therapies 4
- Symptom burden: The patient's symptom burden, including the presence of B symptoms, should be assessed and managed accordingly 4
- Quality of life: The goal of palliative therapies should be to improve the patient's quality of life, rather than to cure the disease 3
Limited Evidence on Specific Palliative Therapies
There is limited evidence on specific palliative therapies for managing B symptoms in DLBCL patients on hospice care. However, studies have shown that palliative therapies, such as corticosteroids and supportive care, can be effective in managing symptoms and improving quality of life 2, 3. Further research is needed to determine the most effective palliative therapies for this patient population.