Treatment Options of Relapsed/Refractory Diffuse Large B cell Lymphoma (DLBCL)

“Relapsed” means the disease comes back after an improvement, while “refractory” means the lymphoma is not responding to treatment or the response is very short-lived.

The majority (Up to 50-60%) of patients with Diffuse Large B cell lymphoma (DLBCL) can be potentially cured with standard chemoimmunotherapy, R-CHOP. 1 Even amongst patients who progress during initial immunochemotherapy or soon after a brief complete remission (meaning the disappearance of all signs of cancer in response to treatment), a standard treatment approach involves high-dose chemotherapy followed by a stem cell transplant. In most cases, these transplants are autologous, meaning the patient receives their own stem cells that were collected before the procedure. About 30% to 40% will achieve disease control with salvage chemotherapy and autologous stem cell transplantation (ASCT). 1

For patients with relapsed or refractory DLBCL after many previous standard lines (R-ICE, R-DHAP, R-GDP) of treatment, the chemotherapy regimens or agents used include (but are not limited to) the following:

  • rituximab, ifosfamide, carboplatin, and etoposide (R-ICE)
  • rituximab, dexamethasone, cisplatin, and cytarabine (R-DHAP)
  • rituximab, gemcitabine, dexamethasone (R-GDP)
  • obinutuzumab-based therapy (Gazyva)
  • bendamustine-based therapy
  • lenalidomide-based (Revlimid)
  • bruton tyrosine kinase inhibitor- based therapy
  • polatuzumab vedotin (Polivy)

However, a proportion of patients with relapsed/refractory DLBCL are unable to receive intensive high-dose chemotherapy or undergo stem cell transplantation due to their age, comorbidities, or disease refractoriness to standard chemotherapy. Also, a subset of patients, the disease remains refractory to many lines of chemoimmunotherapy or relapses after stem cell transplant.

This highlights the need for more effective therapies in this difficult-to-treat population. In recent years, immunotherapy (send hyperlink to my previous article) such as antibody conjugates, bispecific T-cell engager (BiTE), and cellular therapies like CAR-T cell therapy (Chimeric Antigen Receptor T cell) have emerged as potential treatment options for patients with relapsed/refractory DLBCL with the promise of durable long term disease control. Some of them have even been evaluated in clinical trials as a second line therapy (i.e., first relapse after RCHOP to replace ASCT).

Bispecific T cell Engager (BiTE)Chimeric Antigen Receptor T cell
Glofitamab (Columvi)Tisagenlecleucel (Tisa-Cel), (Kymriah)
Epcoritamab (Epkinly)Axicabtagene Ciloleucel (Axi-Cel), (Yescarta)



  1. SCHOLAR-1

The information on the Centre For Clinical Haematology website is intended for educational use.  It should not be considered or used as a substitute for medical advice, diagnosis or treatment from a qualified health professional.

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