Diffuse large B‑cell lymphoma

Summary

Since the introduction of anti-CD20 antibodies and polychemotherapy, diffuse large B‑cell lymphoma (DLBCL) has become a treatable, and, for a high proportion of patients, curable disease. However, a sizeable proportion of patients, especially in poor-prognosis subgroups, will relapse.

The landscape of therapy in DLBCL has seen some exciting changes in the past years, most notably with the introduction of CAR-T-cell therapy. All three major trials were recently updated and showed sustained responses and excellent preliminary survival data.

Other immunotherapies are gaining ground as well, as the antibody–drug conjugate polatuzumab vedotin has shown to be effective in relapsed DLBCL in combination with chemo-immunotherapy (rituximab and bendamustine). Complete remission rates increased from 15 to 40% and overall survival from 4.7 to 11.8 months. Polatuzumab is also being studied in previously untreated patients and results are awaited in 2019.

Checkpoint inhibitors, the mainstay of therapy in a variety of malignancies, are also being studied in DLBCL. Interim results of an ongoing phase I/II study of atezolizumab with R‑CHOP in previously untreated patients show 83% complete remissions in early data.

Other novel substances, like anti-CD47-antibodies and PI3-kinase inhibitors, show promising efficacy in early trials in relapsed patients as well.

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