IIIrd Medical Department at the Paracelsus Medical University Salzburg, Cancer Center, Salzburg; Salzburg Cancer Research Institute, Salzburg; Austrian Group for Medical Tumor Therapy (AGMT), Salzburg; Cancer Cluster, Salzburg, Austria.
IIIrd Medical Department at the Paracelsus Medical University Salzburg, Cancer Center, Salzburg; Salzburg Cancer Research Institute, Salzburg; Austrian Group for Medical Tumor Therapy (AGMT), Salzburg; Cancer Cluster, Salzburg, Austria.
ESMO Open. 2023 Feb;8(1):100750. doi: 10.1016/j.esmoop.2022.100750. Epub 2023 Jan 10.
Diffuse large B-cell lymphoma (DLBCL) is usually treated with chemoimmunotherapy in curative intention at initial diagnosis. Novel agents have improved the prognosis of high-risk patients in the front-line and relapsed setting and more accurate prognostic tools enable less intensive treatment for low-risk patients, while maintaining their good prognosis. Here, we summarize our approach to DLBCL patients in the first-line setting according to their risk profile and other common challenges in clinical practice. We recommend an abbreviated course of chemoimmunotherapy in low-risk patients and a negative interim positron emission tomography. For patients with higher-risk disease, a new combination treatment with polatuzumab vedotin has been approved and is a new option in these patients. We also discuss our approach to patients with high risk for subsequent central nervous system involvement, with leg-type lymphoma or with severe comorbidities.
弥漫性大 B 细胞淋巴瘤（DLBCL）通常在初始诊断时采用化疗联合免疫治疗进行治愈性治疗。新型药物改善了高危患者在一线和复发环境中的预后，更准确的预后工具使低危患者能够接受更少强化的治疗，同时保持良好的预后。在这里，我们根据患者的风险特征和临床实践中的其他常见挑战，总结了我们在一线治疗 DLBCL 患者的方法。我们建议低危患者采用缩短疗程的化疗联合免疫治疗和阴性的中期正电子发射断层扫描（PET）。对于高危疾病患者，新的联合治疗药物 polatuzumab vedotin 已获得批准，是这些患者的新选择。我们还讨论了我们对后续中枢神经系统受累风险高、下肢型淋巴瘤或严重合并症患者的治疗方法。
