While a full-body PET scan is critical for the initial staging of Diffuse Large B-cell Lymphoma, it is not recommended for routine follow-up surveillance after treatment. Post-treatment monitoring shifts to CT scans for the first two years, after which imaging typically stops, highlighting a specific and resource-conscious approach to long-term care.
Though they sound similar, "double hit" and "double expressor" lymphomas are different entities. "Double hit" refers to genetic rearrangements (MYC and BCL2/BCL6), carrying the worst prognosis. "Double expressor" refers to protein overexpression without genetic rearrangement, conferring an intermediate prognosis that is better than double hit.
In relapsed/refractory DLBCL, the timing of relapse is a critical factor in determining the next line of therapy. Patients who relapse within 12 months are preferred candidates for CAR-T therapy. Those relapsing after 12 months may first undergo salvage chemotherapy followed by an autologous stem cell transplant if they respond.
For limited-stage DLBCL, treatment decisions have evolved beyond a simple bulky vs. non-bulky assessment. The NCCN now uses the stage-modified IPI (SMIPI) score. A low score allows for abbreviated chemotherapy, while a high score mandates a more aggressive, advanced-stage treatment pathway regardless of tumor bulk.