Journal: American journal of hematology
This review outlines the current and emerging management strategies for diffuse large B‑cell lymphoma (DLBCL), emphasizing how treatment is being refined by patient fitness, risk profile, and disease setting.
Key points:
- • Frontline treatment (fit patients):
- Standard chemoimmunotherapy remains R‑CHP–based, with pola‑R‑CHP and R‑CHOP as the main options.
- Ongoing trials are testing R‑CHOP combined with novel agents, as well as early use of CAR‑T cells and bispecific antibodies for high‑risk disease.
- • Frontline treatment (elderly/frail patients):
- Dose-attenuated R‑mini‑CHOP is used for selected patients, while others receive palliative approaches.
- New studies are aiming to reduce or omit conventional chemotherapy in this population.
- • Risk-adapted strategies:
- Approaches based on cell of origin (COO) classification and dynamic tools such as interim PET and circulating tumor DNA (ctDNA) are being explored to guide treatment escalation or de‑escalation, but remain investigational.
- • Second‑line curative‑intent therapy:
- Choice between CAR‑T cell therapy and autologous stem cell transplantation depends largely on the timing of relapse after first‑line therapy and other clinical factors.
- • Relapsed/refractory disease:
- The therapeutic landscape is rapidly expanding.
- Combinations include bispecific antibodies with chemotherapy, bispecifics with antibody–drug conjugates, and brentuximab vedotin plus lenalidomide and rituximab.
- Numerous trials are moving further away from conventional chemotherapy, exploring targeted therapy–antibody combinations, new bispecific constructs and combinations, immunomodulatory strategies, and additional cellular therapies.
Overall, the article synthesizes recent data and ongoing trials, highlighting a shift from uniform chemoimmunotherapy toward biology‑ and risk‑adapted, less chemotherapy‑intensive, and more immunotherapy‑focused management of DLBCL.