“I’ve Just Been Diagnosed With DLBCL. Now, What Do I Do?”
Being told you have Diffuse Large B-cell Lymphoma (DLBCL)—a fast-growing, aggressive form of non-Hodgkin lymphoma—can be a lot to take in. Clear information, compassionate guidance, and timely support can make a difference in moments like these. Receiving a diagnosis of DLBCL can feel overwhelming at first—You might be anxious, confused, or unsure about what comes next—and that’s completely understandable. But if you’re in Singapore, take heart: you’re in one of the best places in Asia for advanced cancer care.
DLBCL is not only the most common type of non-Hodgkin lymphoma—it’s also one of the most responsive to treatment. With timely diagnosis, expert medical guidance, and a personalised care plan, many patients go on to achieve remission and lead full, active lives.
What is DLBCL? How is DLBCL diagnosed?
DLBCL is an aggressive but potentially curable cancer of the lymphatic system. It affects B-lymphocytes, the white blood cells responsible for producing antibodies. This type of lymphoma tends to grow quickly, which is why early detection and prompt treatment are so important. Thankfully, many patients respond well to current therapies and achieve long-term remission.
Diagnosis often starts with a biopsy of a swollen lymph node or affected tissue, which helps confirm the presence of lymphoma cells. This is typically followed by imaging tests such as PET-CT scans to determine how far the cancer has spread throughout the body. Blood tests help assess overall health, organ function and detect abnormalities in blood cell counts.
In certain cases, a bone marrow biopsy may be done to check if the lymphoma has infiltrated the bone marrow. “Before starting therapy, we educate patients on their diagnosis and walk them through scans, blood tests, and sometimes lumbar punctures or cardiac assessments. It’s about getting them ready, both physically and emotionally,”— Dr Jason Chan, Senior Consultant, Division of Medical Oncology, National Cancer Centre Singapore.
In some cases, molecular testing such as immunohistochemistry (IHC) and fluorescence in situ hybridisation (FISH) may be performed.
“Most patients don’t undergo full molecular testing before treatment. We rely on immunohistochemistry and FISH to rule out high-risk subtypes like double-hit lymphoma,” said Dr Chan.
Once the cancer is staged—ranging from stage I (localised) to stage IV (widespread)—your medical team will personalise a treatment plan. This plan takes into account your age, general health, type and stage of lymphoma, and any symptoms you may be experiencing. For some genetic tests on the lymphoma cells may also guide treatment by identifying specific subtypes of DLBCL that respond better to certain therapies.
DLBCL First Line Treatment Is Changing—For the Better
For years, the go-to treatment for DLBCL has been R-CHOP—a chemotherapy combination of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone. And while it’s still highly effective, the past few years have brought encouraging progress—especially for patients with higher-risk disease.
A newer first line treatment for DLBCL is Pola-R-CHP, which includes Polatuzumab vedotin, a targeted therapy that delivers chemotherapy directly into cancerous B-cells. Studies have shown that it can extend the time patients live without disease progression, and early data from Singapore support these findings.
How do doctors decide which treatment is right for you?
Several key factors come into play:
- Your IPI Score (International Prognostic Index): This considers your age, disease stage, performance status, number of extranodal sites involved, and blood LDH levels. It helps classify your risk and predict your prognosis.
- DLBCL subtype: Not all DLBCLs are the same. Through gene expression profiling, doctors determine whether yours is a germinal centre B-cell-like (GCB) or activated B-cell-like (ABC), which may respond differently to treatments.
- Your General Health & Medical History: Are you fit for full-dose chemo? Do you have other health issues? These are crucial considerations.
- Access & Affordability: In Singapore, the Cancer Drug List (CDL) plays a significant role in what’s available and reimbursable. R-CHOP and Pola-R-CHP are supported locally.
Here’s a brief explanation of each component of the R-CHOP regimen commonly used to treat DLBCL:
- Rituximab – A monoclonal antibody specifically targeting CD20, a protein found on B-cells, helping the immune system recognise and destroy cancerous B-cells.
- Cyclophosphamide – A chemotherapy drug that interferes with the DNA of cancer cells, stopping them from multiplying.
- Doxorubicin – An anthracycline that kills rapidly dividing cells by damaging their DNA and preventing repair.
- Vincristine – A plant alkaloid that disrupts cancer cell division by interfering with microtubules.
- Prednisolone – A corticosteroid that helps reduce inflammation and has cancer-fighting properties, particularly in blood cancers.
Singapore follows global standards like NICE (UK) and NCCN (US) when treating DLBCL. For patients with intermediate to high-risk DLBCL (based on an IPI score of 2–5), doctors now recommend Pola-R-CHP—a treatment that includes Polatuzumab vedotin (a targeted therapy that attacks cancerous B-cells) along with R-CHOP.
Understanding Your Diagnosis: What to Expect During Testing
Before your treatment begins, your care team will run a series of tests to understand the type and spread of your lymphoma fully.
Each of these helps customise your treatment plan:
- Biopsy (Lymph Node Sample): Where possible, the whole lymph node is removed to give doctors the clearest picture.
- Imaging Scans: CT scans your neck, chest, abdomen and pelvis to locate disease.
- PET-CT scans to see where the cancer is most active.
- Bone Marrow Testing: To check if the lymphoma has reached the bone marrow.
- Blood Tests: To assess your blood counts, organ function and screen for infections.
- Molecular Testing: Including FISH and IHC, which help classify the subtype of DLBCL and guide treatment.
- Lumbar Puncture: If there’s concern about lymphoma affecting the central nervous system, spinal fluid may be tested.
These tests help doctors understand your condition and make the most accurate and effective treatment decisions.
Tailored Treatments for different types of patients
Not everyone is treated the same way—and that’s a good thing.
Side effects from both traditional R-CHOP and newer regimens like Pola-R-CHP can include nausea, fatigue, low blood counts, and hair loss—but doctors now take proactive steps to help you manage treatment more comfortably, as several supportive care measures are put in place.
“We routinely monitor patients to catch any side effects early and adjust their treatment if needed. Comfort and safety are part of the plan from the start,” reassured Dr Chan. This includes hydration support to help protect your kidneys, antiemetic medications to control nausea and vomiting, and growth factors to boost blood cell production and lower the risk of infections.
Depending on your treatment and personal risk, you may also receive antiviral or antibiotic medications to prevent infections. In addition, emotional and psychological support is available to help you cope with anxiety and ensure you’re emotionally supported throughout your treatment journey.
Treatment Access, Costs & The Singapore Healthcare Context
The introduction of the Cancer Drug List (CDL) has improved access to many modern therapies in Singapore—including polatuzumab.
“The Cancer Drug List in Singapore has made it easier for more patients to access newer treatments while keeping healthcare costs affordable. It’s been a real game-changer,” said Dr Chan.
Still, some hurdles remain. Not all medications are covered, and there may be co-payments. Additionally, limited awareness among general practitioners about evolving DLBCL treatments can occasionally lead to delayed referrals. Knowing how to navigate Singapore’s healthcare system and working closely with a specialist early on can help you get the right treatment faster.
The Road Ahead – Promising Research and Personalised Care
“We’re excited about trials involving bispecific antibodies for DLBCL. And with our national lymphoma study expanding, we’re working towards personalised genetic profiling for every patient,” shared Dr Chan. These advances promise more precise and effective treatment pathways in the future.
In Conclusion
A DLBCL diagnosis is life-changing. With the proper treatment and support, many go on to lead full, healthy lives. You’re not alone, and there is a clear path forward.
Talk to your lymphoma specialist in Singapore today about your DLBCL subtype and the first-line treatment plan that’s right for you.
FAQ
Patient Safety and Treatment for Older or Frailer DLBCL Patients
Q1: How is treatment different for older or frailer patients with DLBCL?
Treating older or frailer patients requires a personalised, cautious approach. Regimens are chosen not only for their effectiveness but also for their acceptance, which is why regimens that are effective and well-tolerated are prioritised for elderly or more frail patients.
Q2: What are the treatment options for this group?
- Modified doses of R-CHOP (a standard DLBCL treatment)
- Polatuzumab-based regimens, which show promise in older patients
- Other less intensive chemotherapy combinations depending on patient health and tolerance
Q3: Do newer treatments have different side effects compared to traditional regimens?
Yes. While both R-CHOP and polatuzumab vedotin are associated with known side effects like:
- Nausea
- Hair loss
- Myelosuppression (low blood counts)
Their toxicity profiles may vary slightly, requiring different supportive care strategies.
Q4: How are side effects managed proactively?
Pre-treatment support is needed to reduce discomfort and complications. This includes:
- Hydration: Ensures kidney protection
- Antiemetics: Help prevent nausea and vomiting
- Growth factors: Boost white blood cell counts and reduce infection risk
- Antiviral and antibacterial prophylaxis: Based on regimen and risk profile
- Psychological support: To help patients manage anxiety and emotional stress
Q5: Do side effects indicate how well the treatment is working?
No, side effects do not predict treatment success. However, close monitoring helps doctors spot complications early and adjust the treatment plan as needed for better safety and effectiveness.
References:
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NICE guidelines on Pola in firstline. NICE.ORG. https://www.nice.org.uk/guidance/ta874/chapter/1-Recommendations Accessed May 2025.
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NCCN guidelines on Pola in firstline. NCCN.ORG. https://www.nccn.org/patients/guidelines/content/PDF/nhl-diffuse-patient.pdf (page 47) Accessed May 2025.
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POLARIX trial (the Phase III pivotal trial for polivy). NEJM.ORG. https://www.nejm.org/doi/full/10.1056/NEJMoa2115304 Accessed May 2025.
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Singapore Agency for Care effectiveness Cancer Drug List. ISOMER-USER-CONTENT.BY.GOV. https://isomer-user-content.by.gov.sg/68/6ab1e9cb-b0a0-436b-a378-71faff985d63/pes-polatuzumab-vedotin-for-previously-untreated-diffuse-large-b-cell-lymphoma.pdf Accessed May 2025.
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Polatuzumab Vedotin in Previously Untreated Diffuse Large B-Cell Lymphoma. PUBMED.NCBI.NLM.NIH.GOV..https://pubmed.ncbi.nlm.nih.gov/34904799/ Accessed May 2025.
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A Comprehensive Review of Polatuzumab vedotin: Mechanisms, Clinical Applications, and Future Prospects. NATBOARD.EDU.IN. isomer-user-content.by.gov Accessed May 2025.
