American Board of Internal Medicine (ABIM) Certification Practice Exam

What should be added for patients with bulky disease of diffuse large B-cell lymphoma?

1. Autologous HSCT

2. Involved-field radiation therapy

3. Bone marrow transplant

4. Chemotherapy

The correct answer is: Involved-field radiation therapy

In patients with bulky disease of diffuse large B-cell lymphoma (DLBCL), the addition of involved-field radiation therapy is recommended to enhance treatment effectiveness. Bulky disease refers to a tumor mass that is larger than 10 cm or significant nodal groups that are clinically bulky, which often indicates a higher tumor burden and may not respond as well to chemotherapy alone. Involved-field radiation therapy targets the specific areas of disease and can help reduce the risk of local recurrence, especially when combined with chemotherapy. This approach improves the overall treatment response, particularly in those patients who have not achieved a complete response with chemotherapy. The use of radiation therapy in this context aims to consolidate the remission achieved by systemic therapy, potentially leading to better long-term outcomes. The other options, though beneficial in their own contexts, do not address the specific need for localized disease management in bulky DLBCL. Autologous hematopoietic stem cell transplantation and bone marrow transplant are options typically considered after an initial treatment failure or in certain refractory cases rather than as a frontline approach for bulky disease. Chemotherapy alone may be insufficient for bulky disease, as it may not adequately control or reduce the tumor mass. Hence, involved-field radiation therapy represents the most appropriate adjunctive treatment for patients with