Optimizing First-Line Therapy for Diffuse Large B-Cell Lymphoma

Ash A. Alizadeh

doi:10.6004/jnccn.2025.5058

Optimizing First-Line Therapy for Diffuse Large B-Cell Lymphoma

2025-11-01

0

PRE

AI

A

Ash A. Alizadeh *

DOI：10.6004/jnccn.2025.5058

原文链接

原文求助

摘要

En 中文

The first-line treatment of diffuse large B-cell lymphoma (DLBCL) has evolved with the introduction of Pola-R-CHP (polatuzumab vedotin/ rituximab/cyclophosphamide/doxorubicin/prednisone) as an alternative to the long-standing R-CHOP (rituximab/cyclophosphamide/ doxorubicin/vincristine/prednisone) standard. Although the pivotal POLARIX trial demonstrated a modest progression-free survival benefit for Pola-R-CHP, it showed no overall survival advantage, sparking debate about its universal application. An evidence-based analysis reveals this result to be driven by the profound predictive power of the cell-of-origin molecular subtype. The clinical benefit of Pola-R-CHP seems to be concentrated in patients with the activated B-cell-like (ABC) or nongerminal center B-cell-like (non-GCB) subtype. Conversely, patients with the GCB subtype derive no demonstrable benefit from polatuzumab and are exposed to unnecessary toxicity. Thus, an optimized, biomarker-guided approach is recommended, reserving Pola-R-CHP for patients with non-GCB DLBCL and retaining R-CHOP as the optimal standard for the GCB subtype.

Optimizing First-Line Therapy for Diffuse Large B-Cell Lymphoma

摘要

期刊

机构

引用论文