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.
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.
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.
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.