• When treatment for diffuse large B-cell lymphoma (DLBCL) successfully kills all of your detectable lymphoma cells, it’s considered a complete response (CR), and you’ve achieved remission.
• If you don’t experience a CR or your lymphoma comes back, you may need to try other types of treatments.
• Experiencing a complete response means you’re more likely to have a better prognosis (outlook).

Diffuse large B-cell lymphoma is the most common form of B-cell non-Hodgkin lymphoma (NHL). DLBCL can be treated with a variety of therapies, but the goal is generally a complete response (remission) of the cancer. Doctors may measure how successful your treatment was and predict your outcomes by determining whether you had a complete response or a partial response after a round of treatment.

What Is Remission or a Complete Response?

Doctors may say that you have a complete response — also called complete remission — if, after treatment, all signs of your DLBCL disappear. This means that you no longer have any symptoms, and tests can’t detect any remaining cancer cells.

A CR doesn’t necessarily mean that your DLBCL has been cured. It’s possible that a very small number of lymphoma cells survived treatment and remain behind. There may be so few cancer cells that they can’t be detected with tests, but these cancer cells could still come back later and begin growing again. This is known as a relapse or recurrence.

Among people who have a complete response, fewer than 1 out of 5 will relapse within five years.

What Is a Partial Response in DLBCL?

A partial response or partial remission occurs when treatment helps kill some cancer cells but others remain. Your doctor may say you’re in partial remission if you have less than half of your lymphoma remaining after you go through treatment.

For example, DLBCL may cause cancer to grow in your lymph nodes and other organs such as your spleen or bone marrow. You may have a partial response if treatment shrinks some of your lymph nodes but not others, or if cancer can no longer be found in certain lymph nodes but tests still detect cancer cells in other tissues. In this case, lymphoma symptoms may disappear or they may persist.

Refractory Diffuse Large B-Cell Lymphoma

In some cases, your lymphoma may not respond at all to treatment — it either stays the same or it progresses and worsens. When this happens, you don’t have a complete or partial response. Instead, doctors say that your DLBCL is refractory.

Complete Response and Prognosis

Whether or not you experience a complete response affects your prognosis. Those who go into CR are more likely to experience good outcomes and have a lower chance of relapsing. Four out of 5 people with DLBCL who go into complete response will live at least five years after their initial diagnosis. Doctors refer to this time period as “event-free survival.”

Other factors can also influence your DLBCL prognosis. These factors may include:

• Your age
• Your overall health
• How widespread lymphoma is within your body
• The results of various blood tests

Is DLBCL Remission the Goal of Treatment?

DLBCL is considered a high-grade form of non-Hodgkin lymphoma. In other words, it’s an aggressive lymphoma that grows quickly. Oncologists generally aim for a CR when treating high-grade NHL. These forms of cancer can often go into complete remission or even be cured.

More than 3 out of 4 people with DLBCL reach complete remission after using the standard R-CHOP treatment regimen, according to a 2022 study in Blood Cancer Journal. The term “R-CHOP” comes from the names of the drugs that comprise the regimen, which include rituximab (Rituxan), along with the following four chemotherapy drugs:

• Cyclophosphamide (Cytoxan)
• Doxorubicin (Adriamycin) — also called hydroxydaunorubicin
• Vincristine (Oncovin)
• Prednisolone (Omnipred)

This initial treatment that you receive after diagnosis is called first-line treatment, which may vary somewhat depending on disease prognosis index and how advanced the cancer is.

When DLBCL Comes Back After First-Line Treatment

For people with relapsed or refractory disease, doctors typically recommend second-line treatment. Although lymphoma that returns after first-line therapy is considered high-risk DLBCL that may have a poor prognosis, three types of newer second-line treatment options are significantly extending both event-free survival and prolonged overall survival.

CAR T-Cell Therapy

Chimeric antigen receptor (CAR) T-cell therapy, a newer type of immunotherapy, works by extracting and engineering your T cells to fight lymphoma cells. Three CAR T-cell therapy drugs have been approved to treat DLBCL, including:

• Axicabtagene ciloleucel (Yescarta)
• Lisocabtagene maraleucel (Breyanzi)
• Tisagenlecleucel (Kymriah)

Bispecific Antibodies

Bispecific antibody treatments are another type of immunotherapy that are showing promising results, including epcoritamab-bysp (Epkinly) and glofitamab-gxbm (Columvi). They’re called “bispecific” because they target two types of antigens.

Pola-R-CHP

Pola-R-CHP is a combination chemotherapy regimen. It can be considerably more effective than R-CHOP as a second-line treatment and is sometimes even used as a first-line treatment. Pola-R-CHP is composed of:

• Polatuzumab vedotin-piiq (Polivy)
• Rituximab
• Cyclophosphamide
• Doxorubicin
• Prednisone

How Long Might Complete Response Last?

Doctors can’t predict the duration of response to treatment or just how long you will be in remission. Length of remission can depend on many risk factors, including:

• How old you are
• Whether you have other health problems
• What DLBCL subtype you have
• How aggressive your lymphoma is
• Which treatments you receive
• Whether you can tolerate the side effects of treatment

The longer your CR lasts, the lower your chances of experiencing a relapse. If your lymphoma does relapse, it’s best to detect it and start treatment as soon as possible. It’s important to attend all regular follow-up appointments and get tests to look for any signs that your DLBCL has returned.

Follow-Ups During DLBCL Remission

DLBCL relapses are most likely to happen within two years after treatment. Therefore, your doctor may recommend follow-up visits every couple of months during this period. After that, you may need to be seen just once or twice a year. Doctors generally recommend lab tests during the first five years after treatment completion, whereas scans can generally stop after the first two years. However, you should always tell your doctor right away if you experience any potential DLBCL relapse symptoms.

What Happens When You Don’t Have a Complete Response?

If you have primary refractory disease (your lymphoma doesn’t respond to treatment and you never reach CR) or your DLBCL relapses, your oncologist may recommend second-line treatment options.

Refractory DLBCL and DLBCL that relapses within a year of starting treatment is sometimes treated with bone marrow transplant. People with relapsed or refractory DLBCL may also be able to enroll in oncology clinical trials that offer new treatment options under study in cancer research.

Your health care provider can tell you more about clinical trials and other possible treatments for DLBCL.

Talk With Others Who Understand

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