The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

Treatment of Diffuse Large B Cell Lymphoma

  • Kwak, Jae-Yong (Department of Internal Medicine, Chonbuk National University Medical School)
  • Published : 2012.12.01
⟨ Previous Next ⟩

Abstract

Diffuse large B cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma in all countries and all age groups. DLBCL is potentially curable, and the outcome of patients with DLBCL has completely changed with the introduction of therapy involving the monoclonal antibody rituximab in combination with chemotherapy. Nonetheless, relapse is detected after treatment with rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisolone in approximately 30% of patients. It has recently become clear that DLBCL represents a heterogeneous admixture of quite different entities. Gene expression profiling has uncovered DLBCL subtypes that have distinct clinical behaviors and prognoses; however, incorporation of this information into treatment algorithms awaits further investigation. Future approaches to DLBCL treatment will use this new genetic information to identify potential biomarkers for prognosis and targets for treatment.

Keywords

References

  1. Jaffe ES. The 2008 WHO classification of lymphomas: implications for clinical practice and translational research. Hematology Am Soc Hematol Educ Program 2009;2009:523-531. https://doi.org/10.1182/asheducation-2009.1.523
  2. Swerdlow SH, Campo E, Harris NL, et al. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. 4th ed. Lyon: International Agency for Research on Cancer, 2008.
  3. Alizadeh AA, Eisen MB, Davis RE, et al. Distinct types of diffuse large B-cell lymphoma identified by gene expression profiling. Nature 2000;403:503-511. https://doi.org/10.1038/35000501
  4. Sehn LH, Berry B, Chhanabhai M, et al. The revised International Prognostic Index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP. Blood 2007;109:1857-1861. https://doi.org/10.1182/blood-2006-08-038257
  5. Choi WW, Weisenburger DD, Greiner TC, et al. A new immunostain algorithm classifies diffuse large B-cell lymphoma into molecular subtypes with high accuracy. Clin Cancer Res 2009;15:5494-5502. https://doi.org/10.1158/1078-0432.CCR-09-0113
  6. Hans CP, Weisenburger DD, Greiner TC, et al. Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray. Blood 2004;103:275-282. https://doi.org/10.1182/blood-2003-05-1545
  7. Lossos IS, Czerwinski DK, Alizadeh AA, et al. Prediction of survival in diffuse large-B-cell lymphoma based on the expression of six genes. N Engl J Med 2004;350:1828-1837. https://doi.org/10.1056/NEJMoa032520
  8. Rosenwald A, Wright G, Chan WC, et al. The use of molecular profiling to predict survival after chemotherapy for diffuse large-B-cell lymphoma. N Engl J Med 2002;346:1937-1947. https://doi.org/10.1056/NEJMoa012914
  9. Shipp MA, Ross KN, Tamayo P, et al. Diffuse large B-cell lymphoma outcome prediction by gene-expression profiling and supervised machine learning. Nat Med 2002;8:68-74. https://doi.org/10.1038/nm0102-68
  10. Lee NR, Song EK, Jang KY, et al. Prognostic impact of tumor infiltrating FOXP3 positive regulatory T cells in diffuse large B-cell lymphoma at diagnosis. Leuk Lymphoma 2008;49:247-256. https://doi.org/10.1080/10428190701824536
  11. Coiffier B, Lepage E, Briere J, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med 2002;346:235-242. https://doi.org/10.1056/NEJMoa011795
  12. Habermann TM, Weller EA, Morrison VA, et al. Rituximab-CHOP versus CHOP alone or with maintenance rituximab in older patients with diffuse large B-cell lymphoma. J Clin Oncol 2006;24:3121-3127. https://doi.org/10.1200/JCO.2005.05.1003
  13. Pfreundschuh M, Schubert J, Ziepert M, et al. Six versus eight cycles of bi-weekly CHOP-14 with or without rituximab in elderly patients with aggressive CD20+ B-cell lymphomas: a randomised controlled trial (RICOVER-60). Lancet Oncol 2008;9:105-116. https://doi.org/10.1016/S1470-2045(08)70002-0
  14. Pfreundschuh M, Trumper L, Osterborg A, et al. CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera International Trial (MInT) Group. Lancet Oncol 2006;7:379-391. https://doi.org/10.1016/S1470-2045(06)70664-7
  15. Sehn LH, Donaldson J, Chhanabhai M, et al. Introduction of combined CHOP plus rituximab therapy dramatically improved outcome of diffuse large B-cell lymphoma in British Columbia. J Clin Oncol 2005;23:5027-5033. https://doi.org/10.1200/JCO.2005.09.137
  16. Fisher RI, Gaynor ER, Dahlberg S, et al. Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkin's lymphoma. N Engl J Med 1993;328:1002-1006. https://doi.org/10.1056/NEJM199304083281404
  17. Klimo P, Connors JM. MACOP-B chemotherapy for the treatment of diffuse large-cell lymphoma. Ann Intern Med 1985;102:596-602. https://doi.org/10.7326/0003-4819-102-5-596
  18. Shipp MA, Harrington DP, Klatt MM, et al. Identification of major prognostic subgroups of patients with large-cell lymphoma treated with m-BACOD or M-BACOD. Ann Intern Med 1986;104:757-765. https://doi.org/10.7326/0003-4819-104-6-757
  19. Browne MJ, Hubbard SM, Longo DL, et al. Excess prevalence of Pneumocystis carinii pneumonia in patients treated for lymphoma with combination chemotherapy. Ann Intern Med 1986;104:338-344. https://doi.org/10.7326/0003-4819-104-3-338
  20. Itoh K, Ohtsu T, Wakita H, et al. Dose-escalation study of CHOP with or without prophylactic G-CSF in aggressive non-Hodgkin's lymphoma. Ann Oncol 2000;11:1241-1247. https://doi.org/10.1023/A:1008361513544
  21. Linch DC, Smith P, Hancock BW, et al. A randomized British National Lymphoma Investigation trial of CHOP vs. a weekly multi-agent regimen (PACEBOM) in patients with histologically aggressive non-Hodgkin's lymphoma. Ann Oncol 2000;11 Suppl 1:87-90. https://doi.org/10.1093/annonc/11.suppl_1.S87
  22. Tilly H, Lepage E, Coiffier B, et al. Intensive conventional chemotherapy (ACVBP regimen) compared with standard CHOP for poor-prognosis aggressive non-Hodgkin lymphoma. Blood 2003;102:4284-4289. https://doi.org/10.1182/blood-2003-02-0542
  23. Pfreundschuh M, Trumper L, Kloess M, et al. Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of elderly patients with aggressive lymphomas: results of the NHL-B2 trial of the DSHNHL. Blood 2004;104:634-641. https://doi.org/10.1182/blood-2003-06-2095
  24. Pfreundschuh M, Trumper L, Kloess M, et al. Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of young patients with good-prognosis (normal LDH) aggressive lymphomas: results of the NHL-B1 trial of the DSHNHL. Blood 2004;104:626-633. https://doi.org/10.1182/blood-2003-06-2094
  25. Coiffier B, Haioun C, Ketterer N, et al. Rituximab (anti-CD20 monoclonal antibody) for the treatment of patients with relapsing or refractory aggressive lymphoma: a multicenter phase II study. Blood 1998;92:1927-1932.
  26. Cartron G, Watier H, Golay J, Solal-Celigny P. From the bench to the bedside: ways to improve rituximab efficacy. Blood 2004;104:2635-2642. https://doi.org/10.1182/blood-2004-03-1110
  27. Coiffier B, Feugier P, Mounier N, et al. Long-term results of the GELA study comparing R-CHOP and CHOP chemotherapy in older patients with diffuse large B-cell lymphoma show good survival in poor-risk patients [abstract]. J Clin Oncol 2007;25(18 suppl):8009.
  28. Shenkier TN, Voss N, Fairey R, et al. Brief chemotherapy and involved-region irradiation for limited-stage diffuse large-cell lymphoma: an 18-year experience from the British Columbia Cancer Agency. J Clin Oncol 2002;20:197-204. https://doi.org/10.1200/JCO.20.1.197
  29. Horning SJ, Weller E, Kim K, et al. Chemotherapy with or without radiotherapy in limited-stage diffuse aggressive non-Hodgkin's lymphoma: Eastern Cooperative Oncology Group study 1484. J Clin Oncol 2004;22:3032-3038. https://doi.org/10.1200/JCO.2004.06.088
  30. Phan J, Mazloom A, Medeiros LJ, et al. Benefit of consolidative radiation therapy in patients with diffuse large B-cell lymphoma treated with R-CHOP chemotherapy. J Clin Oncol 2010;28:4170-4176. https://doi.org/10.1200/JCO.2009.27.3441
  31. Feugier P, Van Hoof A, Sebban C, et al. Long-term results of the R-CHOP study in the treatment of elderly patients with diffuse large B-cell lymphoma: a study by the Groupe d'Etude des Lymphomes de l'Adulte. J Clin Oncol 2005;23:4117-4126. https://doi.org/10.1200/JCO.2005.09.131
  32. Canales MA, de la Serna J, Sabin P, et al. Up-front treatment of diffuse large-b cell lymphoma (DLBCL) in elderly patients with rituximab in combination with CHOP-like chemotherapy: a multicenter study on the current clinical management [abstract]. Blood 2005;106:4778.
  33. Pfreundschuh M, Ziepert M, Zeynalova S, et al. Six versus eight cycles of biweekly CHOP-14 with or without R in elderly patients (pts) with aggressive CD20+ B-cell lymphomas: Seven-year FU of the RICOVER-60 trial of the DSHNHL [abstract]. J Clin Oncol 2011;29(15 suppl):8029. https://doi.org/10.1200/jco.2011.29.15_suppl.8029
  34. Purroy N, Lopez A, Vallespi T, Gironella M, Bergua J, Sancho JM. Dose-adjusted EPOCH plus rituximab (DA-EPOCH-R) in untreated patients with poor risk large B-cell lymphoma. A phase 2 study conducted by the Spanish PETHEMA group [abstract]. Blood 2009;114:2701.
  35. Delarue R, Tilly H, Salles G, et al. R-CHOP14 compared to R-CHOP21 in elderly patients with diffuse large B-cell lymphoma: results of the interim analysis of the LNH03-6B GELA study [abstract]. Blood 2009;114:406.
  36. Recher C, Coiffier B, Haioun C, et al. Intensified chemotherapy with ACVBP plus rituximab versus standard CHOP plus rituximab for the treatment of diffuse large B-cell lymphoma (LNH03-2B): an open-label randomised phase 3 trial. Lancet 2011;378:1858-1867. https://doi.org/10.1016/S0140-6736(11)61040-4
  37. Reyes F, Lepage E, Ganem G, et al. ACVBP versus CHOP plus radiotherapy for localized aggressive lymphoma. N Engl J Med 2005;352:1197-1205. https://doi.org/10.1056/NEJMoa042040
  38. Wilson WH, Dunleavy K, Pittaluga S, et al. Phase II study of dose-adjusted EPOCH and rituximab in untreated diffuse large B-cell lymphoma with analysis of germinal center and post-germinal center biomarkers. J Clin Oncol 2008;26:2717-2724. https://doi.org/10.1200/JCO.2007.13.1391
  39. Lenz G, Wright GW, Emre NC, et al. Molecular subtypes of diffuse large B-cell lymphoma arise by distinct genetic pathways. Proc Natl Acad Sci U S A 2008;105:13520-13525. https://doi.org/10.1073/pnas.0804295105
  40. Wiestner A, Staudt LM. Towards molecular diagnosis and targeted therapy of lymphoid malignancies. Semin Hematol 2003;40:296-307. https://doi.org/10.1016/S0037-1963(03)00194-X
  41. Fu K, Weisenburger DD, Choi WW, et al. Addition of rituximab to standard chemotherapy improves the survival of both the germinal center B-cell-like and non-germinal center B-cell-like subtypes of diffuse large B-cell lymphoma. J Clin Oncol 2008;26:4587-4594. https://doi.org/10.1200/JCO.2007.15.9277
  42. Meyer PN, Fu K, Greiner TC, et al. Immunohistochemical methods for predicting cell of origin and survival in patients with diffuse large B-cell lymphoma treated with rituximab. J Clin Oncol 2011;29:200-207. https://doi.org/10.1200/JCO.2010.30.0368
  43. Dunleavy K, Janik J, Gea-Banacloche J, et al. Phase I/II study of bortezomib alone and bortezomib with dose-adjusted EPOCH chemotherapy in relapsed or refractory aggressive B-cell lymphoma [abstract]. Blood 2004;104:1385.
  44. de Jong D, Xie W, Rosenwald A, et al. Immunohistochemical prognostic markers in diffuse large B-cell lymphoma: validation of tissue microarray as a prerequisite for broad clinical applications (a study from the Lunenburg Lymphoma Biomarker Consortium). J Clin Pathol 2009;62:128-138. https://doi.org/10.1136/jcp.2008.057257
  45. Bagg A. B cells behaving badly: a better basis to behold belligerence in B-cell lymphomas. Hematology Am Soc Hematol Educ Program 2011;2011:330-335. https://doi.org/10.1182/asheducation-2011.1.330
  46. Gutierrez-Garcia G, Cardesa-Salzmann T, Climent F, et al. Gene-expression profiling and not immunophenotypic algorithms predicts prognosis in patients with diffuse large B-cell lymphoma treated with immunochemotherapy. Blood 2011;117:4836-4843. https://doi.org/10.1182/blood-2010-12-322362
  47. Mounier N, Briere J, Gisselbrecht C, et al. Rituximab plus CHOP (R-CHOP) overcomes bcl-2: associated resistance to chemotherapy in elderly patients with diffuse large B-cell lymphoma (DLBCL). Blood 2003;101:4279-4284. https://doi.org/10.1182/blood-2002-11-3442
  48. Winter JN, Weller EA, Horning SJ, et al. Prognostic significance of Bcl-6 protein expression in DLBCL treated with CHOP or R-CHOP: a prospective correlative study. Blood 2006;107:4207-4213. https://doi.org/10.1182/blood-2005-10-4222
  49. Nyman H, Adde M, Karjalainen-Lindsberg ML, et al. Prognostic impact of immunohistochemically defined germinal center phenotype in diffuse large B-cell lymphoma patients treated with immunochemotherapy. Blood 2007;109:4930-4935. https://doi.org/10.1182/blood-2006-09-047068
  50. Saito B, Shiozawa E, Usui T, et al. Rituximab with chemotherapy improves survival of non-germinal center type untreated diffuse large B-cell lymphoma. Leukemia 2007;21:2563-2566. https://doi.org/10.1038/sj.leu.2404844
  51. Phan RT, Dalla-Favera R. The BCL6 proto-oncogene suppresses p53 expression in germinal-centre B cells. Nature 2004;432:635-639. https://doi.org/10.1038/nature03147
  52. Paik JH, Jeon YK, Park SS, et al. Expression and prognostic implications of cell cycle regulatory molecules, p16, p21, p27, p14 and p53 in germinal centre and non-germinal centre B-like diffuse large B-cell lymphomas. Histopathology 2005;47:281-291. https://doi.org/10.1111/j.1365-2559.2005.02222.x
  53. Wilson WH, Teruya-Feldstein J, Fest T, et al. Relationship of p53, bcl-2, and tumor proliferation to clinical drug resistance in non-Hodgkin's lymphomas. Blood 1997;89:601-609.
  54. Ranuncolo SM, Polo JM, Dierov J, et al. Bcl-6 mediates the germinal center B cell phenotype and lymphomagenesis through transcriptional repression of the DNA-damage sensor ATR. Nat Immunol 2007;8:705-714. https://doi.org/10.1038/ni1478
  55. Pasqualucci L, Migliazza A, Basso K, Houldsworth J, Chaganti RS, Dalla-Favera R. Mutations of the BCL6 proto-oncogene disrupt its negative autoregulation in diffuse large B-cell lymphoma. Blood 2003;101:2914-2923. https://doi.org/10.1182/blood-2002-11-3387
  56. Kurosu T, Fukuda T, Miki T, Miura O. BCL6 overexpression prevents increase in reactive oxygen species and inhibits apoptosis induced by chemotherapeutic reagents in B-cell lymphoma cells. Oncogene 2003;22:4459-4468. https://doi.org/10.1038/sj.onc.1206755
  57. Allen C, Saigal K, Nottingham L, Arun P, Chen Z, Van Waes C. Bortezomib-induced apoptosis with limited clinical response is accompanied by inhibition of canonical but not alternative nuclear factor-{kappa}B subunits in head and neck cancer. Clin Cancer Res 2008;14:4175-4185. https://doi.org/10.1158/1078-0432.CCR-07-4470
  58. Houldsworth J, Petlakh M, Olshen AB, Chaganti RS. Pathway activation in large B-cell non-Hodgkin lymphoma cell lines by doxorubicin reveals prognostic markers of in vivo response. Leuk Lymphoma 2008;49:2170-2180. https://doi.org/10.1080/10428190802428369
  59. Strauss SJ, Higginbottom K, Juliger S, et al. The proteasome inhibitor bortezomib acts independently of p53 and induces cell death via apoptosis and mitotic catastrophe in B-cell lymphoma cell lines. Cancer Res 2007;67:2783-2790. https://doi.org/10.1158/0008-5472.CAN-06-3254
  60. Ruan J, Martin P, Furman RR, et al. Bortezomib plus CHOP-rituximab for previously untreated diffuse large B-cell lymphoma and mantle cell lymphoma. J Clin Oncol 2011;29:690-697. https://doi.org/10.1200/JCO.2010.31.1142
  61. Hernandez-Ilizaliturri FJ, Deeb G, Zinzani PL, et al. Response of relapsed/refractory diffuse large B-cell lymphoma (DLBCL) with nongerminal center B-cell phenotype to lenalidomide (L) alone or in combination with rituximab (R) [abstract]. J Clin Oncol 2010;28(15 suppl):8038. https://doi.org/10.1200/jco.2010.28.15_suppl.8038
  62. Olivieri A, Santini G, Patti C, et al. Upfront high-dose sequential therapy (HDS) versus VACOP-B with or without HDS in aggressive non-Hodgkin's lymphoma: long-term results by the NHLCSG. Ann Oncol 2005;16:1941-1948. https://doi.org/10.1093/annonc/mdi399
  63. Vellenga E, van Putten WL, van 't Veer MB, et al. Rituximab improves the treatment results of DHAP-VIM-DHAP and ASCT in relapsed/progressive aggressive CD20+ NHL: a prospective randomized HOVON trial. Blood 2008;111:537-543. https://doi.org/10.1182/blood-2007-08-108415
  64. Fenske TS, Hari PN, Carreras J, et al. Impact of pre-transplant rituximab on survival after autologous hematopoietic stem cell transplantation for diffuse large B cell lymphoma. Biol Blood Marrow Transplant 2009;15:1455-1464. https://doi.org/10.1016/j.bbmt.2009.07.017
  65. Kewalramani T, Zelenetz AD, Nimer SD, et al. Rituximab and ICE as second-line therapy before autologous stem cell transplantation for relapsed or primary refractory diffuse large B-cell lymphoma. Blood 2004;103:3684-3688. https://doi.org/10.1182/blood-2003-11-3911
  66. Martin A, Conde E, Arnan M, et al. R-ESHAP as salvage therapy for patients with relapsed or refractory diffuse large B-cell lymphoma: the influence of prior exposure to rituximab on outcome. A GEL/TAMO study. Haematologica 2008;93:1829-1836. https://doi.org/10.3324/haematol.13440
  67. Gisselbrecht C, Glass B, Mounier N, et al. Salvage regimens with autologous transplantation for relapsed large B-cell lymphoma in the rituximab era. J Clin Oncol 2010;28:4184-4190. https://doi.org/10.1200/JCO.2010.28.1618
  68. Gisselbrecht C, Glass B, Mounier N, et al. R-ICE versus R-DHAP in relapsed patients with CD20 diffuse large B-cell lymphoma (DLBCL) followed by autologous stem cell transplantation: CORAL study [abstract]. J Clin Oncol 2009;27(15 suppl):8509.
  69. Lazarus HM, Zhang MJ, Carreras J, et al. A comparison of HLA-identical sibling allogeneic versus autologous transplantation for diffuse large B cell lymphoma: a report from the CIBMTR. Biol Blood Marrow Transplant 2010;16:35-45. https://doi.org/10.1016/j.bbmt.2009.08.011
  70. Aksentijevich I, Jones RJ, Ambinder RF, Garrett-Mayer E, Flinn IW. Clinical outcome following autologous and allogeneic blood and marrow transplantation for relapsed diffuse large-cell non-Hodgkin's lymphoma. Biol Blood Marrow Transplant 2006;12:965-972. https://doi.org/10.1016/j.bbmt.2006.05.018
  71. Vose JM, Sharp G, Chan WC, et al. Autologous transplantation for aggressive non-Hodgkin's lymphoma: results of a randomized trial evaluating graft source and minimal residual disease. J Clin Oncol 2002;20:2344-2352. https://doi.org/10.1200/JCO.2002.09.138
  72. van Imhoff GW, van der Holt B, Mackenzie MA, et al. Impact of three courses of intensified CHOP prior to high-dose sequential therapy followed by autologous stem-cell transplantation as first-line treatment in poor-risk, aggressive non-hodgkin's lymphoma: comparative analysis of Dutch-Belgian Hemato-Oncology Cooperative Group Studies 27 and 40. J Clin Oncol 2005;23:3793-3801. https://doi.org/10.1200/JCO.2005.07.039

Cited by

  1. Clinical significance of nuclear factor κB and chemokine receptor CXCR4 expression in patients with diffuse large B-cell lymphoma who received rituximab-based therapy vol.29, pp.6, 2012, https://doi.org/10.3904/kjim.2014.29.6.785
  2. Successful Salvage Treatment for Isolated Brain Parenchymal Relapse due to Diffuse Large B Cell Lymphoma vol.88, pp.2, 2015, https://doi.org/10.3904/kjm.2015.88.2.218
  3. High expression of Bcl-2 predicts poor outcome in diffuse large B-cell lymphoma patients with low international prognostic index receiving R-CHOP chemotherapy vol.103, pp.2, 2012, https://doi.org/10.1007/s12185-015-1911-0
  4. Clinical outcomes in patients with diffuse large B cell lymphoma with a partial response to first-line R-CHOP chemotherapy: prognostic value of secondary International Prognostic Index scores and Deau vol.96, pp.11, 2012, https://doi.org/10.1007/s00277-017-3107-6
  5. Primary pituitary diffuse large B-cell lymphoma with somatotroph hyperplasia and acromegaly: case report vol.126, pp.5, 2017, https://doi.org/10.3171/2016.5.jns16828
  6. Primary pituitary diffuse large B-cell lymphoma with somatotroph hyperplasia and acromegaly: case report vol.126, pp.5, 2017, https://doi.org/10.3171/2016.5.jns16828
  7. The prognostic significance of CD11b + CX3CR1 + monocytes in patients with newly diagnosed diffuse large B-cell lymphoma vol.8, pp.54, 2012, https://doi.org/10.18632/oncotarget.21241
  8. The effect of the dexamethasone, cytarabine, and cisplatin (DHAP) regimen on stem cell mobilization and transplant outcomes of patients with non-Hodgkin’s lymphoma who are candidates for up-front aut vol.33, pp.6, 2012, https://doi.org/10.3904/kjim.2016.163
  9. Identification of Hub Genes and Key Pathways Associated with Two Subtypes of Diffuse Large B-Cell Lymphoma Based on Gene Expression Profiling via Integrated Bioinformatics vol.2018, pp.None, 2012, https://doi.org/10.1155/2018/3574534
  10. Non-Hodgkin lymphoma as primary bone tumor in a patient with B hepatic viral infection - case report vol.1, pp.1, 2018, https://doi.org/10.2478/rojost-2018-0004
  11. Figurate erythema for 20 years vol.5, pp.6, 2012, https://doi.org/10.1016/j.jdcr.2019.02.032
  12. Early risk stratification for diffuse large B-cell lymphoma integrating interim Deauville score and International Prognostic Index vol.98, pp.12, 2012, https://doi.org/10.1007/s00277-019-03834-4
  13. First-Line Treatment for Primary Breast Diffuse Large B-Cell Lymphoma Using Immunochemotherapy and Central Nervous System Prophylaxis: A Multicenter Phase 2 Trial vol.12, pp.8, 2012, https://doi.org/10.3390/cancers12082192
  14. Disseminated soft tissue diffuse large B-cell lymphoma involving multiple abdominal wall muscles: A case report vol.9, pp.28, 2012, https://doi.org/10.12998/wjcc.v9.i28.8557