What is the first-line therapy for diffuse large B-cell lymphoma?

• A. CHOP without rituximab
• B. ABVD regimen
• C. R-ICE regimen
• D. R-CHOP regimen

Answer: (D)

R-CHOP is the first-line therapy for diffuse large B-cell lymphoma because it combines targeted immunotherapy with conventional chemotherapy to improve outcomes in CD20-positive B-cell lymphomas. Rituximab binds the CD20 antigen on B cells, flagging them for immune destruction, while CHOP—cyclophosphamide, doxorubicin, vincristine, and prednisone—provides strong cytotoxic action against rapidly dividing lymphoma cells. The synergy between rituximab and CHOP has consistently shown higher response rates and longer survival than CHOP alone, making this combination the standard frontline approach for most patients.

This regimen is typically given in cycles every three weeks, up to about six cycles, with adjustments based on stage, patient age, and comorbidities. The other regimens are not first-line for DLBCL: ABVD is used for classical Hodgkin lymphoma, and R-ICE is a salvage option for relapsed or refractory disease. CHOP without rituximab was a former standard, but rituximab’s addition is now essential for frontline therapy in most patients.