Developments in the treatment of recurrent diffuse large B-cell lymphoma

Background and purposeRefractory or relapsed diffuse large B-cell lymphoma (r/r DLBCL) is difficult to treat with conventional polychemotherapy. Adoptive T-cell therapy with chimeric antigen receptors (CAR T-cell therapy) and antibody-based developments of immunotherapeutics have fundamentally changed the treatment. This review summarises the influence of the standard-defining studies on the treatment algorithm. Materials and methodsThis work is based on a selective literature search in the PubMed database on the topic of primary refractory and relapsed DLBCL in conjunction with the S3 guideline on DLBCL from the Association of the Scientific Medical Societies in Germany (AWMF) and the current recommendations of the German Society of Haematology and Oncology (DGHO). ResultsIn second-line therapy, CD19-directed CAR T-cell therapy with axicabtagene ciloleucel or lisocabtagene maraleucel is standard therapy for patients at a high risk of further treatment failure, as demonstrated by reliable phase III studies. A high-risk situation is defined by primary refractory disease or relapse within 1 year of first-line therapy. Another new option is the use of bispecific antibodies. In third-line therapy, bispecific antibodies targeting CD20 can achieve high remission rates. Assessment of the curative potential of this modality requires further follow-up. Combining a bispecific antibody with conventional chemotherapy in patients who are not eligible for high-dose chemotherapy demonstrates the additive potential of these therapeutic principles. ConclusionIn summary, the current immunotherapeutic developments have greatly improved the prognosis of patients with r/r DLBCL.