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ABSTRACT
Introduction: Recent genetic and molecular discoveries regarding alterations in diffuse large B-cell lymphoma (DLBCL) deeply changed the approach to this lymphoproliferative disorder. Novel additional predictors of outcomes and new therapeutic strategies are being introduced to improve outcomes.
Areas covered: This review aims to analyse the recent molecular discoveries in DLBCL, the rationale of novel molecular driven treatments and their impact on DLBCL prognosis, especially in ABC-DLBCL and High Grade B Cell Lymphoma. Pre-clinical and clinical evidences are reviewed to critically evaluate the novel DLBCL management strategies.
Expert commentary: New insights in DLBCL molecular characteristics should guide the therapeutic approach; the results of the current studies which are investigating safety and efficacy of novel ‘X-RCHOP’ will probably lead, in future, to a cell of origin (COO) based upfront therapy. Moreover, it is necessary to identify early patients with DLBCL who carried MYC, BCL2 and/or BCL6 rearrangements double hit lymphomas (DHL) because they should not receive standard R-CHOP but high intensity treatment as reported in many retrospective studies. New prospective trials are needed to investigate the more appropriate treatment of DHL.
Declaration of interest
M Martelli reports grants and personal fees from Roche, Mundipharma, Celgene, Sandoz, Janssen and Pftizer. R Foà reports grants and personal fees from Roche, Mundipharma, Genentech, Janssen Gilead, Celgene and Amgen. The other co- authors have no other relevant affiliations or financial involvement with any financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.