Diffuse large B-cell lymphoma.
Diffuse large B-cell lymphoma.
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DOI：
10.1002/hon.3202
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发表时间：
2023-07
影响因子：
3.3
通讯作者：
A. Barraclough;E. Hawkes;L. Sehn;Sonali M. Smith
中科院分区：
文献类型：
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作者：
A. Barraclough;E. Hawkes;L. Sehn;Sonali M. Smith
大B细胞淋巴瘤是侵袭性非霍奇金淋巴瘤的原型，是最常见的淋巴瘤，也是全球淋巴瘤相关死亡的最高负担。近40年来，治疗的目标一直是“治愈”，首先是基于CHOP（环磷酰胺，多柔比星，长春新碱，泼尼松），随后是利妥昔单抗加CHOP。然而，有显着的临床，病理和生物异质性，并不是所有的患者都治愈。不幸的是，理解这种生物异质性并将其纳入治疗决策尚未成为标准治疗。尽管存在这一差距，但我们现在在一线、复发和难治性疾病方面取得了重大进展。POLARIX试验首次显示，在前瞻性随机III期研究中，无进展生存率得到改善。在复发性和难治性环境中，现在有许多批准的药剂/方案，并且几种双特异性抗体准备加入选择的武库。虽然嵌合抗原受体T细胞疗法在其他地方详细讨论，但它已迅速成为二线及其他领域的绝佳选择。不幸的是，老年人等特殊人群的结果仍然很差，在试验中的代表性不足，尽管新一代试验旨在解决这一差异。这篇简短的综述将强调为越来越多的患者提供改善结局的关键问题和进展。
Large B-cell lymphoma, the prototype of aggressive non-Hodgkin lymphomas, is both the most common lymphoma and accounts for the highest global burden of lymphoma-related deaths. For nearly 4 decades, the goal of treatment has been "cure", first based on CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone), and subsequently with rituximab plus CHOP. However, there is significant clinical, pathologic, and biologic heterogeneity, and not all patients are cured. Understanding and incorporating this biologic heterogeneity into treatment decisions unfortunately is not yet standard of care. Despite this gap, we now have significant advances in frontline, relapsed, and refractory settings. The POLARIX trial shows, for the first time, improved progression-free survival in a prospective randomized phase 3 setting. In the relapsed and refractory settings, there are now many approved agents/regimens, and several bispecific antibodies poised to join the arsenal of options. While chimeric antigen receptor T-cell therapy is discussed in detail elsewhere, it has quickly become an excellent option in the second-line setting and beyond. Unfortunately, special populations such as older adults continue to have poor outcomes and be underrepresented in trials, although a new generation of trials aim to address this disparity. This brief review will highlight the key issues and advances that offer improved outcomes to an increasing portion of patients.