High-grade B-cell lymphoma

High-grade B-cell lymphoma is an aggressive (fast-growing) type of non-Hodgkin lymphoma (NHL). It is a unique subset of diffuse large B-cell lymphoma (DLBCL). It may also be called double-hit lymphoma or triple-hit lymphoma. "Hits" refers to the number of genes in the lymphoma cells that have been changed.

Double-hit lymphoma has rearrangements in the MYC gene and in either the BCL2 gene or the BCL6 gene.

Triple-hit lymphoma has rearrangements in the MYC gene, BCL2 gene and BCL6 gene.

Your healthcare team will suggest treatments for high-grade B-cell lymphoma based on your needs and work with you to develop a treatment plan. When suggesting treatments, they will consider:

• the stage of lymphoma
• if you have symptoms
• your age
• your general health
• your preferences

The following are treatment options for high-grade B-cell lymphoma.

Chemotherapy uses drugs to destroy cancer cells. It is the main treatment for high-grade B-cell lymphoma. It is often combined with a targeted therapy drug.

The most common drug combination used to treat high-grade B-cell lymphoma is DA-EPOCH-R. DA-EPOCH-R is dose-adjusted etoposide (Vepesid), prednisone, vincristine, cyclophosphamide (Procytox), doxorubicin and rituximab (Rituxan and biosimilars).

High-grade B-cell lymphoma can spread to the brain and spinal cord (called the central nervous system, or CNS). Chemotherapy is used to prevent lymphoma cells from entering the tissue covering the brain and spinal cord. This is called CNS prophylaxis. It may be given as intrathecal chemotherapy. This means that the chemotherapy drugs are injected into the cerebrospinal fluid (CSF). Methotrexate is commonly used in CNS prophylaxis.

If high-grade B-cell lymphoma comes back (relapses) after being treated or doesn’t respond to treatment (called refractory disease), you may be offered the following chemotherapy combinations:

• R-GDP – rituximab, gemcitabine, dexamethasone and cisplatin
• R-ICE – rituximab, ifosfamide (Ifex), carboplatin and etoposide
• GDP – gemcitabine, dexamethasone and cisplatin
• R-DHAP – rituximab, dexamethasone, cytarabine (Cytosar) and cisplatin
• R-GemOX – rituximab, gemcitabine and oxaliplatin
• Pola-BR – polatuzumab vedotin, bendamustine (Treanda, Benvyon, Esamuze) and rituximab

Find out more about chemotherapy for NHL.

A stem cell transplant replaces stem cells when stem cells, the bone marrow or both are damaged. A stem cell transplant is very risky and complex, and it must be done in a special transplant centre or hospital.

You may be offered an autologous stem cell transplant for high-grade B-cell lymphoma that comes back after treatment (relapses) or doesn't respond to treatment (called refractory disease). This type of transplant uses your own stem cells rather than a donor's.

Your healthcare team may suggest stem cell transplant as a treatment option if:

• you are generally healthy
• lymphoma responds to chemotherapy (called chemosensitive)
• lymphoma hasn't spread to the central nervous system (CNS)
• your organs are working normally

Find out more about stem cell transplant for NHL.

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells while limiting harm to normal cells. Targeted therapy may also be called molecular targeted therapy.

Targeted therapy may be used alone or in combination with chemotherapy or immunotherapy to treat high-grade B-cell lymphoma.

The most common targeted therapy drug used is rituximab. Other targeted therapy drugs that may be used to treat relapsed or refractory high-grade B-cell lymphoma include:

• polatuzumab vedotin (Polivy)
• tafasitamab (Minjuvi) in combination with lenalidomide (Revlimid)

These targeted therapy drugs may not be covered by all provincial or territorial health plans.

Find out more about targeted therapy for NHL.

Immunotherapy helps to strengthen or restore the immune system's ability to fight cancer. It is sometimes used to treat high-grade B-cell lymphoma. The following immunotherapy drugs may not be covered by all provincial and territorial health plans.

Your healthcare team may offer the immunotherapy called CAR T-cell therapy as a treatment option if:

• you have had 2 or more other types of chemotherapy
• you are generally healthy and your organs are working well
• you haven't received T-cell immunotherapy before
• lymphoma hasn't spread to the central nervous system (CNS)

The following drugs may be used in CAR T-cell therapy:

• tisagenlecleucel (Kymriah)
• axicabtagene ciloleucel (Yescarta)
• lisocabatagene maraleucel (Breyanzi)

Bispecific antibodies are a new type of immunotherapy. They may be used to treat high-grade B-cell lymphoma after 2 or more lines of systemic therapy and if you previously had CAR T-cell therapy or if you can't have CAR T-cell therapy.

The following bispecific antibodies may be offered:

• epcoritamab (Epkinly)
• glofitamab (Columvi)

Find out more about immunotherapy for NHL.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. It may be used after chemotherapy to treat the areas of the body affected by lymphoma.

Find out more about radiation therapy for NHL.

Talk to your doctor about clinical trials open to people with NHL in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.