NEW DELHI: India continues to see a steady rise in the incidence of lymphoma, the most common type of blood cancer. But among all the different types of lymphoma, nearly 30-40% of patients in India are diagnosed with Diffuse Large B-cell lymphoma (DLBCL), or B-cell lymphoma, which is the most aggressive and common form of high-grade non-Hodgkin lymphoma (NHL). NHL is the 10th most common type of cancer in India and over 41,000 new cases are reported every year.
DLBCL is a blood cancer that starts in white blood cells called lymphocytes and usually grows in lymph nodes. Nearly 40% of DLBCL patients face relapse or disease progression, creating significant challenges for patients, their families and the healthcare system. According to experts, those diagnosed with DLBCL do not survive for more than five years, which is worse than the global average.
According to Dr Sajjan Rajpurohit, senior director, BLK-Max Super Speciality Hospital, DLBCL alone accounts for around 25,000 cancer cases annually in the country. “In India, the incidences of DLBCL amongst NHL cases is higher compared to western populations,” he said, adding that if in India it accounts for 60%, in the Western world, it is 25%. The disease is more frequently seen in older adults, with a median age of 54 years at diagnosis.
The higher incidence of DLBCL in India can be attributed to several factors such as India’s unique environmental exposures, the prevalence of infectious diseases, genetic variations, diagnostic practices and reporting standards, said Dr Peush Bajpai, head of the department and consultant, Medical Hemato Oncologist, Manipal Hospital, Dwarka, Delhi.
One of the key challenges in treating DLBCL is misdiagnosis and delayed referrals from general physicians, which can disrupt the patient’s treatment journey and compromise effectiveness.
Dr Rajpurohit said that the symptoms of DLBCL, a fast-growing lymphoma that progresses quickly and typically requires prompt treatment, can be non-specific and sometimes mistaken for more common infections like tuberculosis, thus leading to delays in proper diagnosis.
The symptoms are swollen lymph nodes in the neck, armpits, or groin, shortness of breath, chest pain, fatigue, weight loss, loss of appetite, fever, muscle weakness, bone and joint pain, and itchy skin. Lymphoma is diagnosed through a series of tests and procedures that help determine if cancer is present in the lymphatic system.
“Once lymphoma is confirmed, further tests are done to determine the stage of the cancer, how far it has spread. This helps guide treatment decisions. Lymphoma is diagnosed primarily through the biopsy of a lymph node, followed by imaging tests and blood work to determine the extent of the disease,” he said.
The prognosis of DLBCL is generally good, with many cases being both treatable and curable, especially with prompt and appropriate treatment. “DLBCL is considered a curable lymphoma, especially in patients who achieve a complete remission after initial treatment. Up to 50-60% of DLBCL patients can be cured with first-line therapy. However, prognosis is generally better for patients diagnosed at an early stage (Stage I or II). So, it is crucial to offer the most effective initial treatment,” he added.
While many patients are responsive to initial treatment, as many as four in ten do not respond to initial therapy or relapse within two years after initial treatment. These patients face limited treatment options, which adds to the emotional and psychological toll on them and their families, who live in constant fear of the disease returning.
The current treatment regimen is known as the R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), which is a standard first-line therapy for DLBCL for the past two decades. But now, there is renewed hope as the first US Food and Drug Administration-approved therapy for first-line treatment of DLBCL is available in India after a long gap of 20 years. Experts said this new treatment promises to reduce the chances of the disease getting worse, relapsing, or causing death by 27% compared to current treatment options available in the country.
The new treatment, Polatuzumab, is an antibody-drug conjugate (ADC), which targets specific proteins in lymphoma cells and delivers cytotoxic agents directly to the cancer cell. “By adopting innovative therapies like polatuzumab as the new standard of care (SoC) in first-line treatment, we can increase the chances of cure while easing the financial and emotional burden of relapse or disease progression. This shift would be crucial in improving both survival rate and quality of life for DLBCL patients in India,” said Dr Pawan Singh, director, Hematology, Yatharth Super Speciality Hospital.
Dr Sushant Mittal, director of Medical Oncology at Action Cancer Hospital, said the new drug is quite tolerable and safe for patients, and there is significant benefit seen in high-risk groups, too. Experts said the treatment with the new regimen showed that 77% of patients were progression-free for two years, thus providing a lifeline to those who previously had limited options. Over 23,000 patients have been treated in the first-line setting under the new regimen. The drug is now approved in more than 90 countries. In India, it has been available since December 2023.
Dr. Bajpai said that to reduce the risk of DLBCL, one should maintain a healthy weight through a balanced diet and exercise and minimise exposure to harmful substances. “While these measures can help lower your risk, they do not guarantee prevention,” he said.