Sequencing therapy in relapsed DLBCL

Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoid malignancy worldwide, comprising approximately 30 % of all lym pho mas. Currently, 50 % to 60 % of patients diag nosed with DLBCL are alive at 5 years and cured with modern ther apy, but about 10 % to 15 % of patients are refrac tory to fi rst - line ther apy, and an addi tional 20 % to 30 % relapse fol low ing a com plete response. Patients who have relapses beyond 2 years may expe ri ence more favor able out comes and have forms of DLBCL that can be dis tin guished bio log i cally. Patients who expe ri ence early relapse or who have primary refrac tory dis ease (less than a com plete response or relapse within 3 to 6 months of ini tial ther apy) have worse out comes. For decades, the stan dard of care treat ment strat egy for fi t patients with relapsed DLBCL has been sal vage therapy with non-cross-resistant combination chemoimmunotherapy regimens followed by high-dose chemotherapy and autol o gous stem cell trans plan ta tion (ASCT) as stem cell res cue for patients with chemosensitive dis ease. Recent data sug gest that cer tain patients may ben e fit from chi me ric anti gen recep tor T - cell ther apy (CAR T) in the sec ond - line set ting. Additional novel ther a pies exist for patients who are inel i gi ble, who are unable to access these ther a pies, or who fail ASCT and / or CAR T. Despite the advent of new ther a pies for DLBCL and improved out comes, DLBCL remains a life threat en ing ill ness. Thus, it is essen tial for cli ni cians to engage in seri ous ill ness con ver sa tions with their patients. Goals of - care com mu ni ca tion can be improved through skills - based train ing and has been dem on strated to have an impact on patient experiences.