Standard of Care in First-Line Therapy of DLBCL

Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma entity accounting for about 40% of the global lymphoma burden [1]. Approximately 60% of patients are cured with frontline chemoimmunotherapy, with most relapses occurring within the first 2 years from diagnosis. While some of the patients with relapsed disease can be salvaged with aggressive chemotherapy and transplant approaches, the majority of patients who relapse after modern frontline therapy will succumb to the disease [2, 3]. Not surprisingly, a great effort has been undertaken to improve outcomes of frontline treatment and increase cure rates in newly diagnosed DLBCL. DLBCL is unique with respect to the number and the quality of studies providing level 1 evidence which treatment should be considered. In addition to unmet clinical needs, two factors resulted in successful development of randomized studies in DLBCL: it is a common lymphoma enabling fast accrual to prospective studies and it runs an aggressive clinical course allowing for relatively quick readout of study endpoints. However, it is now recognized that DLBCL is a molecularly diverse disease, with several distinct molecular subtypes showing different outcomes and responsiveness to therapy [4]. These molecular subtypes described in Chap. 2 will drive future developments of novel therapies in DLBCL. Nonetheless, the large diversity of the clinical presentation of DLBCL including increasing patient age, comorbidities, and performance status will remain important variables affecting therapy selection and outcomes.