A 67-year-old man is diagnosed with diffuse large B-cell lymphoma (DLBCL), stage II bulky, germinal center B-cell (GCB) subtype by Hans algorithm. PET-CT shows SUVmax 18. IPI score is 2 (intermediate risk). According to current NCCN guidelines, the standard first-line therapy is:

• A Pola-R-CHP x 6 cycles ✓
• B R-CHOP x 6 cycles
• C CHOP x 8 cycles without rituximab
• D Bendamustine + rituximab x 6 cycles

Explanation

POLARIX trial (2021, NEJM) demonstrated that polatuzumab vedotin–R-CHP (Pola-R-CHP) significantly improved 2-year progression-free survival compared to R-CHOP (76.7% vs 70.2%) in previously untreated DLBCL patients with IPI ≥2. Pola-R-CHP was approved by FDA/EMA and is now included in NCCN guidelines as a preferred first-line regimen for intermediate/high-risk DLBCL in patients ≥18 years. R-CHOP remains an acceptable alternative but Pola-R-CHP has superior PFS in the IPI ≥2 population. CHOP without rituximab is substandard therapy.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.