All content on this site is intended for healthcare professionals only. By acknowledging this message and accessing the information on this website you are confirming that you are a Healthcare Professional. If you are a patient or carer, please visit the Lymphoma Coalition.
The lym Hub website uses a third-party service provided by Google that dynamically translates web content. Translations are machine generated, so may not be an exact or complete translation, and the lym Hub cannot guarantee the accuracy of translated content. The lym and its employees will not be liable for any direct, indirect, or consequential damages (even if foreseeable) resulting from use of the Google Translate feature. For further support with Google Translate, visit Google Translate Help.
The Lymphoma & CLL Hub is an independent medical education platform, sponsored by AbbVie, BeOne Medicines, Johnson & Johnson, Roche and sobi, and supported through educational grants from Bristol Myers Squibb, Incyte and Lilly. View funders.
Now you can support HCPs in making informed decisions for their patients
Your contribution helps us continuously deliver expertly curated content to HCPs worldwide. You will also have the opportunity to make a content suggestion for consideration and receive updates on the impact contributions are making to our content.
Find out more
Create an account and access these new features:
Bookmark content to read later
Select your specific areas of interest
View lymphoma & CLL content recommended for you
Diagnosis and staging
According to the European Society for Medical Oncology (ESMO), the diagnosis of Diffuse Large B-Cell Lymphoma (DLBCL) should include an excision biopsy to assess the nodal architecture and provide adequate specimen for phenotypic and molecular studies. Needle core biopsy is only recommended in patients in whom a surgical approach is not possible or advised.1 Immunophenotypic investigations should provide a morphological diagnosis of DLBCL using immunohistochemistry, flow cytometry or both. EBER-1 staining is recommended to identify Epstein-Barr Virus (EBV). Diagnosis should be carried out according to the current World Health Organization (WHO) classification.1,2 Hepatitis B virus testing is included due to the risk of reactivation prior to treatment with CD20 monoclonal antibodies. Hepatitis C testing is required in high-risk patients and patients with splenic Marginal Zone Lymphoma.3
Staging is done according to the Ann Arbor classification system (Table 1), although a new staging system has been proposed but has not yet been validated.4
Stage
Description
I
Involvement of a single lymphatic region (I) or localized involvement of single extralymphatic organ or site (IE)
II
Involvement of two or more lymphatic regions on the same side of the diaphragm (II) or localized involvement of a single extralymphatic organ or site and of one or more lymphatic regions on the same side of the diaphragm (IIE)
III
Involvement of lymphatic regions on both sides of the diaphragm
IV
Diffuse or disseminated involvement of one or more extralymphatic organs with or without lymphatic involvement
The International Prognostic Index (IPI) and age-adjusted IPI (aaIPI) should also be calculated for prognostic purposes (Table 2).
IPI1
Risk factors: Age >60 years; Serum LDH >normal; Stage III–IV; Performance status 2–4; Extranodal sites >1
Risk categories
Score
Estimated 3-year Overall Survival (95% CI)1
Low
0–1
91 (89–94)
Low intermediate
2
81 (73–86)
High intermediate
3
65 (58–73)
High
4–5
59 (49–69)
Age adjusted IPI (aaIPI) in patients ≤60 years1
Risk factors: Serum LDH >normal; Stage III–IV; Performance status 2–4
Risk categories
Score
Estimated 3-year Overall Survival (95% CI)3
Low
0
98 (96–100)
Low intermediate
1
92 (87–95)
High intermediate
2
75 (66–82)
High
3
75 (66–82)
References
Your opinion matters
In your experience, when do most CRS/ICANS events occur after lisocabtagene maraleucel infusion?