Miyazaki Kana
Department of Hematology and Oncology, Mie University Graduate School of Medicine.
Rinsho Ketsueki. 2024;65(9):995-1003. doi: 10.11406/rinketsu.65.995.
Diffuse large B-cell lymphoma (DLBCL) accounts for approximately 40% of all malignant lymphomas, making it the most common subtype. Molecular genetic studies have elucidated the pathogenesis of DLBCL and the causes of its poor prognosis. This basic research has led to the development of novel molecularly targeted therapies that target molecules and cellular antigens in relevant signaling pathways or epigenetic enzymes. Treatment with polatuzumab vedotin, rituximab, cyclophosphamide, doxorubicin, and prednisone has become the standard of care for newly diagnosed CD20-positive DLBCL with an International Prognostic Index score of 2 to 5, based on its reported efficacy for this indication. In addition, the development of immunotherapy such as anti-CD19-chimeric antigen receptor (CAR)-T therapy and bispecific antibodies such as epcoritamab, mosunetuzumab, and glofitamab has led to a paradigm shift in treatment of relapsed/refractory DLBCL. This review summarizes the evolution of treatment development for DLBCL, as well as the results of the current clinical standard of care and new therapies that are expected to become the standard of care.
弥漫性大B细胞淋巴瘤（DLBCL）约占所有恶性淋巴瘤的40%，是最常见的亚型。分子遗传学研究阐明了DLBCL的发病机制及其预后不良的原因。这项基础研究催生了新型分子靶向疗法，这些疗法针对相关信号通路中的分子和细胞抗原或表观遗传酶。基于其在该适应症上报道的疗效，使用泊洛妥珠单抗、利妥昔单抗、环磷酰胺、多柔比星和泼尼松进行治疗已成为国际预后指数评分为2至5的新诊断CD20阳性DLBCL的标准治疗方案。此外，抗CD19嵌合抗原受体（CAR）-T疗法等免疫疗法以及epcoritamab、mosunetuzumab和glofitamab等双特异性抗体的发展，导致复发/难治性DLBCL的治疗发生了范式转变。本综述总结了DLBCL治疗发展的演变，以及当前临床标准治疗的结果和有望成为标准治疗的新疗法。
