Diffuse large B-cell lymphoma (DLBCL): treatment options and a guide to care in China

A guide to DLBCL care in China, including its advantages, leading hospitals and specialists

Prepared and published by SinoCareHub Huayitong International Medical

A report diagnosing diffuse large B-cell lymphoma can be frightening. Let's begin by explaining the disease in plain language.

DLBCL is the most common aggressive non-Hodgkin lymphoma. It starts in B lymphocytes, immune cells that help fight infection. In DLBCL, abnormal B cells multiply rapidly and spread through the lymph nodes and other organs, where they can compress and damage normal tissues.

Common signs and symptoms

Painless enlarged lymph nodes in the neck, armpit or groin

Unexplained fever, night sweats or significant weight loss over a short period

Persistent fatigue and poor appetite

Abdominal pain, bloating and a marked feeling of fullness when the gastrointestinal tract is affected

Cough, chest tightness and difficulty breathing when lymph nodes in the mediastinum are enlarged

DLBCL can progress quickly, but it is also among the lymphomas with higher cure rates. With standard first-line treatment, many patients achieve long-term remission or even a clinical cure.

💡 DLBCL is not a uniform disease. Pathology can distinguish GCB from non-GCB disease. Dual expression of MYC and BCL2 proteins and gene rearrangements detected by FISH are different findings. Doctors also assess Epstein–Barr virus status and the risk of central nervous system involvement and use these findings with the stage to plan treatment.

Assessment and scheduling

Haematology centres in China can arrange tests, pathology review and multidisciplinary consultation. Timing depends on whether specimens are available and when tests and consultations can be scheduled. Confirm with the receiving hospital.

A typical pathway is an outpatient visit, pathology review, staging and molecular tests as needed, multidisciplinary discussion, then a treatment plan.

Common tests, selected by the doctor for each case

Laboratory tests

Common tests include a full blood count, liver and kidney function, LDH, and screening for hepatitis B, hepatitis C and HIV. The doctor decides when to add tests such as beta-2 microglobulin, erythrocyte sedimentation rate, Epstein–Barr virus or pregnancy testing.

Imaging

PET-CT is the main tool for staging and assessing response. The doctor decides whether to add contrast-enhanced CT, brain MRI or gastrointestinal endoscopy based on the suspected sites and the purpose of testing.

Pathology and molecular testing

Immunohistochemistry can include markers such as CD20, CD79b, BCL2, BCL6, MYC, Ki-67, MUM1 and p53. The pathology team chooses the panel.

FISH can detect rearrangements in MYC, BCL2 and BCL6 to help identify high-risk pathological types.

Flow cytometry, gene copy-number testing and next-generation sequencing (NGS) are selected as needed. For patients at high risk of central nervous system involvement, the doctor assesses whether to test cerebrospinal fluid.

Treatment costs and written estimates

Costs vary by hospital, regimen, targeted drug or CAR-T product. Ask the hospital to itemise the following when preparing an estimate.

Pre-admission staging costs

Costs of R-CHOP cycles and supportive care

Costs of Pola-R-CHP or other targeted combinations

CAR-T product cost and related charges for collection, admission and monitoring

If you are considering special access in Lecheng, check the approved use, availability and charges with the designated hospital in the zone.

⚠️ Final costs depend on the hospital’s assessment and the treatment regimen. SinoCareHub can help request a written estimate from the hospital.

Treatment options range from curative first-line regimens to newer therapies for relapsed or refractory disease

(1) First-line treatment for newly diagnosed DLBCL in China

The standard backbone is R-CHOP, which combines rituximab with CHOP chemotherapy.

Other options depend on the stage, risk, pathological type and general health.

Pola-R-CHP is an option for some previously untreated patients at intermediate or high risk. POLARIX enrolled 879 patients with an IPI score of 2–5.

CR-CHOP combines chidamide with R-CHOP. A phase III trial studied it in MYC/BCL2 double-expressor DLBCL. The treating team assesses whether to use it. Phase III trial

A specialist team may consider DA-EPOCH-R for selected high-risk pathological subtypes. In a randomised DLBCL trial, it had greater toxicity and showed no overall advantage over R-CHOP. CALGB 50303 trial

R-miniCHOP: a less intensive regimen for older or frail patients who cannot tolerate intensified chemotherapy

R-CHOP usually follows a 21-day cycle. The total number of cycles depends on the stage, risk and regimen. Some patients with low-risk, limited-stage disease can have a shorter course. The doctor decides when to repeat PET-CT and whether to investigate further before changing treatment. Chinese lymphoma guidelines

Indicative first-line outcomes

In previously untreated patients at intermediate or high risk in POLARIX, five-year progression-free survival was 64.9% with Pola-R-CHP and 59.1% with R-CHOP. These figures describe progression-free survival in the trial population and do not predict an individual’s chance of cure. POLARIX five-year follow-up

(2) Treatment in China for relapsed or refractory DLBCL

For relapsed or refractory disease, doctors consider the following options based on prior treatment, time to relapse and general health.

① Salvage therapy and autologous stem cell transplantation: a transplant team can assess patients who relapse more than 12 months after finishing first-line treatment, are fit for intensive treatment and respond to salvage therapy. EHA clinical guideline

② CD19 CAR-T: products are approved in China. Some adults with large B-cell lymphoma refractory to first-line immunochemotherapy or relapsing within 12 months of completing it can be assessed for axicabtagene ciloleucel. In heavily pretreated patients with relapsed or refractory large B-cell lymphoma, the RELIANCE trial of relmacabtagene autoleucel reported a 77.59% objective response rate and a 53.45% complete response rate. Confirm eligibility and manufacturing times with the centre. Axicabtagene ciloleucel indication RELIANCE trial

③ Bispecific antibodies: China’s regulator has conditionally approved glofitamab for adults with relapsed or refractory DLBCL after at least two prior lines of systemic therapy. NMPA approval

④ Targeted combinations: specialists may assess options such as tafasitamab plus lenalidomide for some patients who are not candidates for autologous transplantation. EHA clinical guideline

⑤ Special access in Boao Lecheng: designated facilities may apply to import a clinically urgent medicine already marketed abroad, where the medicine is not approved in China and no marketed domestic alternative can substitute for it. Use is subject to the terms of the approval. Hainan regulator’s application guide

Hainan's Boao Lecheng International Medical Tourism Pilot Zone has a special authorisation policy for medicines and medical devices. It is an important route for international patients seeking newer medicines from abroad.

Patients can ask facilities in the zone, including Ruijin Hainan Hospital or West China Lecheng Hospital. The hospital must confirm approved uses, eligibility and availability separately for any specific medicine, CAR-T therapy or clinical study.

A typical care pathway

Submit pathology reports for preliminary review. Arrange travel to Lecheng once the hospital confirms it can see you, what it needs to review on arrival and what options it can offer. The treating team plans treatment and follow-up. Confirm English-language support in advance.

1. Peking Union Medical College Hospital (Beijing)

A leading Grade III Class A general hospital and a first choice for complex lymphoma cases or patients with underlying conditions. It has nationally leading haematology, pathology and infection management teams, with expertise in differential diagnosis and multidisciplinary treatment of DLBCL involving multiple organs.

2. Ruijin Hospital, Shanghai Jiao Tong University School of Medicine (Shanghai), and Ruijin Hainan Hospital (Lecheng)

Ruijin Hospital conducts lymphoma research and provides CAR-T therapy. If you are considering Ruijin Hainan Hospital, check the indications, availability and admission arrangements for the specific medicine or CAR-T programme.

3. West China Hospital, Sichuan University (Chengdu)

One of China's largest haematology centres. It was among the first to run multiple trials of Chinese-developed CAR-T and bispecific antibodies, has a dedicated clinic for relapsed or refractory lymphoma, and is experienced in treating refractory DLBCL and disease outside the lymph nodes.

Other options include Peking University People's Hospital, Lu Daopei Hospital, Huashan Hospital in Shanghai and Tongji Hospital, Huazhong University of Science and Technology.

Beijing

Zhou Daobin | Peking Union Medical College Hospital

Haematologist specialising in malignant lymphomas, leukaemia, haematopoietic stem cell transplantation and individualised treatment of complex lymphoma cases.

Duan Minghui | Peking Union Medical College Hospital

Focuses on lymphoma and myeloproliferative disorders, with expertise in combined treatment and transplant assessment for complex, refractory lymphoma.

Lu Peihua | Lu Daopei Medical Group

Internationally recognised CAR-T specialist licensed in China and the United States, with a longstanding focus on cellular immunotherapy for relapsed or refractory lymphoma.

Huang Xiaojun | Peking University People's Hospital

A leading Chinese haematopoietic stem cell transplant specialist with expertise in transplant regimens for high-risk relapsed or refractory DLBCL.

Shanghai

Zhao Weili | Ruijin Hospital, Shanghai Jiao Tong University School of Medicine

A leader in precision medicine for lymphoma, leads multiple real-world studies of new DLBCL drugs and CAR-T and is responsible for clinical work with newer medicines in Lecheng.

Chen Bobin | Huashan Hospital, Fudan University

Focuses on molecular classification of DLBCL and specialises in combining targeted and immune treatments for aggressive lymphoma.

Chengdu and Wuhan

Niu Ting | West China Hospital, Sichuan University

A specialist in lymphoid disorders who studies targeted therapy combined with immunotherapy for high-risk DLBCL.

Zou Liqun | West China Hospital, Sichuan University

Focuses on relapsed or refractory B-cell lymphoma and extranodal DLBCL, with extensive CAR-T experience.

Zhou Jianfeng (deceased) | Former head of haematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology

He helped advance CAR-T research and clinical care in China and died in 2022. Contact Tongji Hospital’s haematology department for current appointment arrangements. Tongji Hospital memorial

New treatment options in Boao Lecheng

You Jianhua | Ruijin Hainan Hospital (Lecheng)

Oversees the introduction of innovative drugs under Lecheng's special authorisation policy and develops treatment pathways involving newer medicines and immunotherapies for international patients.

Specialist appointments, admission and treatment depend on assessment by the hospital and treating doctor. SinoCareHub coordinates referrals and cannot guarantee a particular specialist or admission.

Common challenges for international patients include language barriers, unfamiliar hospital procedures, uncertainty about how to submit records, missing documents for visas and questions about how CAR-T works.

SinoCareHub Huayitong International Medical coordinates travel to China for medical care. You can focus on treatment while we handle the coordination.

The standard steps

Review of your records before booking flights

Send us the pathology slides and reports, original PET-CT images in DICOM format, records of previous chemotherapy and medication, and discharge summaries. We check the records for completeness and tell you what is missing and whether translation or organisation is needed.

Matching you with a hospital and doctor

Based on your condition, budget and needs, such as standard first-line care, CAR-T or a specially authorised drug in Boao Lecheng, we identify suitable hospitals, help submit records, contact the appropriate department and follow up.

Remote video consultation (required)

Whether or not you can travel easily, prepare carefully and obtain a professional assessment before booking flights, accommodation and travel. A remote video consultation with a DLBCL specialist in China can give you preliminary recommendations and information about the treatment plan, duration and cost. It helps you decide whether travel is needed and whether your current condition makes it suitable. This is an important part of planning responsibly.

Formal booking and estimated costs

After reviewing your records, the hospital confirms whether it can see you and provides an estimated cost and timeline. We send you the formal English documents.

Documents for a medical visa

We help you prepare the required documents, such as the hospital's medical invitation letter, and guide you through the visa application process.

Arrangements for your stay

We help book accommodation and arrange professional medical interpreting, accompaniment at appointments and airport transfers, with bilingual coordination throughout.

Support during treatment and follow-up after returning home

We help patients and clinicians communicate during admission. After discharge, we help organise and translate the hospital’s records and coordinate follow-up. The treating team determines the tests and timing.

Disclaimer: SinoCareHub provides information, care coordination, trip planning, interpreting, accompaniment and help organising documents. It does not provide diagnostic or treatment advice or replace a doctor's diagnosis. Acceptance, appointments, treatment and admission depend on the final decision of the hospital and treating doctor.

Q: Can I use my overseas pathology report? Are Chinese pathology results reliable?

A: Reports and records from abroad can be used for review. Bring the original pathology report with immunohistochemistry details, H&E and immunostained slides, any available paraffin blocks or unstained slides, and existing FISH or NGS reports. The pathology team can review existing tissue first and perform additional tests on it if needed.

A doctor may recommend another biopsy if there is too little tissue, the sample quality is poor or the subtype cannot be resolved. The team may also recommend a new biopsy if it suspects relapse or transformation. A pathology team with experience diagnosing lymphoma performs the tests and reports the findings. EHA clinical guideline

Q: Can I get treatment if I do not speak Chinese?

A: SinoCareHub can arrange medical interpreting and accompaniment. Before you travel, confirm which documents the hospital provides in English and which need translation.

Q: How soon can I start treatment?

A: The receiving hospital confirms timing for remote consultation, in-person visits and treatment based on available records, test results and scheduling. CAR-T also requires time for cell collection, manufacturing and assessment before infusion.

Q: How do I get follow-up care after I return home?

A: Before discharge, ask the treating team about follow-up tests and timing, which documents are available in English and whom to contact if problems arise. SinoCareHub can help coordinate remote follow-up.

Q: Can I ask to see a particular specialist?

A: We prioritise your preferred specialist. The hospital manages the specialist's schedule and admission authority. We can coordinate the request, but cannot guarantee acceptance.

If you or a family member has DLBCL and would like to learn about treatment options or whether a trip to China is feasible, please contact us.

👥 Service provider: Huayitong International Medical Services (Hainan) Co., Ltd.

🌐 Official website: https://sinocarehub.com

✅ Services: preliminary records review, hospital and specialist matching, remote video consultations, appointment coordination, medical invitation letters, medical interpreting, appointment accompaniment and travel planning

👉 Send us the pathology, imaging, test reports and treatment records you already have. SinoCareHub will coordinate the remaining steps so you can focus on treatment.