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Treatment of Aggressive B Cell Lymphomas: Updates in 2019

  • T-Cell and Other Lymphoproliferative Malignancies (J Zain, Section Editor)
  • Published:
Current Hematologic Malignancy Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Recent years have seen the development of gene expression profiling and next-generation sequencing in diffuse large B cell lymphoma (DLBCL), leading to a more defined characterization of this disease into distinct subentities. The genomic era has ushered in the possibility of using precision guided therapy, in part based on targeting genes with somatic mutations. Such precision-targeted therapies will ultimately reduce the need for chemotherapy, induce fewer adverse events, and likely enhance the cure rate for these patients. Here, we discuss emerging therapeutic strategies that have been recently developed for the upfront and relapse setting of DLBCL.

Recent Findings

Clinical trials exploring precision medicine have showed promising results; however, attempts to enhance frontline immunochemotherapy by adding targeted agents to the R-CHOP backbone did not confirm the expected benefit. The last decade has also seen a revolutionary development of immunotherapy in B cell lymphomas. While cellular immunotherapy demonstrated a striking success of CAR T cells in DLBCL, checkpoint inhibitors have lacked success in B cell lymphomas. A parallel therapeutic expansion has involved bispecific monoclonal antibodies as a powerful tool for redirected T cell therapy independently from costimulatory molecules and major-histocompatibility complex.

Summary

The landscape of drugs for the treatment of DLBCL has become overwhelmed by the increasing number of targeted and immunological therapies; however, none have enhanced efficacy of frontline therapy. Future direction should focus to redefine therapeutic paradigm and develop mechanism-based combinatorial regimens specifically tailored for DLBCL genetic subgroups.

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  1. Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Patrizia Mondello

  2. Division of Hematology and Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA

    Patrizia Mondello & Grzegorz S. Nowakowski

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Patrizia Mondello declares that she has no conflict of interest.

Grzegorz S. Nowakowski has received research funding from Celgene, MorphoSys, Bayer and Kymera, has received research funding from Curis, F. Hoffmann-La Roche Lts, Genentech, NanoString, and is a member on advisory committees of Selvita.

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Mondello, P., Nowakowski, G.S. Treatment of Aggressive B Cell Lymphomas: Updates in 2019. Curr Hematol Malig Rep 15, 225–234 (2020). https://doi.org/10.1007/s11899-020-00581-6

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