Vol 52, No 4 (2021)
Review article
Published online: 2021-08-31
Improving first-line treatment in diffuse large B-cell lymphoma
DOI: 10.5603/AHP.2021.0061
Acta Haematol Pol 2021;52(4):320-324.
Abstract
R-CHOP remains the standard of care in first-line treatment of diffuse large B-cell lymphoma (DLBCL), the most common lymphoma subtype. Patients who fail this therapy have a poor outcome, with relapse or refractory disease resulting in fatality in the majority.
In this short paper, we summarize recent clinical studies exploring alternative regimens and efficacy of autologous stem cell transplantation (ASCT) consolidations. In ABC DLBCL, adequately identifying patients with poor prognosis but failed to recognize the patient for molecular target of therapy. Immunotherapy, which may potentially be used in less well genetically characterized patients, is most potent if used relative to chemotherapy protocols, therefore its optional combination remains to be determined. The hope is ultimately to move away from a universal chemotherapeutic mentality towards an individualized approach, be it through the use of a targeted small molecule or a biological drug.
We discuss the role of new monoclonal antibodies such as obinutuzumab, brentuximab vedotin, polatuzumab vedotin and bispecific antibodies (BIABs) in first-line treatment regimens. BIABs which can bind to two different antigens at the same time are under investigation. After neurotoxic blinatumomab, anti-CD20/anti-CD3 BIABs take the lead, and due to their favorable toxicity profile they can be used in elderly patients with comorbidities, causing durable responses in patients with B-cell non-Hodgkin lymphoma who otherwise have limited options, even in those relapsing or refractory to chimeric antigen receptor (CAR) T-cell therapy.
Keywords: DLBCLtargeted molecular therapiesimmunotherapy
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