Navigating the Evolving Treatment Landscape of Diffuse Large B-Cell Lymphoma

Abstract

Diffuse large B-cell lymphoma, the most common subtype of non-Hodgkin lymphoma, comprises a heterogenous group of morphologically, genetically, and clinically distinct diseases. Several recent advances have affected the treatment landscape, which had been mostly stagnant for the past few decades. We will review the practice-changing studies in frontline (POLARIX), early relapse (ZUMA-7 and TRANSFORM), and multiple recurrent (ZUMA-1, JULIET, TRANSCEND, L-MIND, and LOTIS-2) stages and discuss how the treatment landscape may evolve with the emergence of bispecific antibodies.

The Impact of Genetic Subtypes of Diffuse Large B-Cell Lymphoma for Outcome Prediction and Interpretation of FDG-PET treatment Response Monitoring

“…High rates of treatment failure on R-CHOP in patients with DFCI-C2 DLBCL may argue for early treatment conversion or immediate experimental programs. For all other patients especially those with low stage/low risk disease, initial treatment with R-CHOP should remain the rst treatment choice [21]. Only those few patients that remain PET-positive may be diverted to genetically-targeted and/or immunologically-directed treatment.…”

“…Since R-CHOP treatment in the discovery cohorts as well as in these independent series was heterogeneous, the predictive value for primary response and outcome under standard R-CHOP treatment has not been fully resolved. This has been one of the major reasons that has precluded inclusion of genetic subtypes in prognostic models to complement the gold standard of the International Prognostic Index (IPI) [1,16,[21][22][23][24]. Lack of consensus on signi cant genetic drivers de ning proposed clusters in a uni ed concept has further contributed to the decision that implementation of genetic subtyping in the newest Lymphoma Classi cations is too early [2,3].…”

The present state of primary ovarian lymphoma: a case report and twenty years of analysis

“…Through analysis of the pathological examination, researchers identi ed the tumor as high-grade aggressive malignant B-cell lymphoma, namely diffuse large B-cell lymphoma (DLBCL), which could be classi ed into two subtypes: germinal center B-cell-like (GCB) and non-GCB, distinguished by the expression of immune markers CD10, BCL-6, and MUM-1. Combined with the Hans classi cation and IHC results, the de nitive pathological diagnosis of the case was DLBCL (GCB subtype) with a better prognosis than DLBCL (non-GCB subtype) [3] .…”

Flow cytometry quantification of tumor-infiltrating lymphocytes to predict the survival of patients with diffuse large B-cell lymphoma

“…In the past two decades, a great deal of effort has been devoted to improving the clinical outcome of R-CHOP as the frontline treatment for DLBCL, including shortening the interval between treatment cycles, intensifying the treatment, or incorporating new drugs alongside R-CHOP. However, these efforts have not yielded successful results (2)(3)(4).…”