Early detection of patients with poor risk diffuse large B-cell lymphoma.

More than 60% of patients with diffuse large B-cell lymphoma (DLBCL) will be cured with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). However, the outcome following secondary therapies remains poor. Early identification of high-risk patients would allow alternative treatment strategies to be considered. Clinical prognostic factors, such as the International Prognostic Index remain useful, but can no longer identify patients with a very poor outcome. Identification of molecular prognostic markers will be required to improve risk stratification. A large number of molecular markers have been reported to be prognostic in patients with DLBCL treated with CHOP, and more recently with R-CHOP. These markers require further validation before clinical utility can be established. Continuous reassessment of clinical and molecular markers in the context of prospective clinical trials is necessary to ensure ongoing relevance.