Oncology Brothers: Practice-Changing Cancer Discussions How to Treat Diffuse Large B-Cell Lymphoma (DLBCL) in 2025
Jul 17, 2025
In this discussion, esteemed lymphoma expert Dr. John Leonard from NYU Langone Cancer Center delves into the complexities of treating diffuse large B-cell lymphoma (DLBCL). He highlights the evolving management strategies, particularly the promising Pola-R-CHP regimen and its implications for Stage 1 and 2 diseases. Dr. Leonard also explores the emerging options for relapsed cases, including CAR-T therapy and bispecific antibodies, while emphasizing the importance of tailoring treatments for various patient profiles.
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Consider Pola-R-CHP As First-Line For Fit Patients
- For fit advanced-stage patients, favor Pola-R-CHP as first-line because the Polarix trial was positive and broadly enrolled IPI≥2 patients.
- Prefer Pola especially for non-GCB/ABC subtype where benefit seems stronger.
Titrate Intensity For Frail Patients
- Tailor regimens for frail elders: use mini-R-CHOP or consider mini Pola-R-CHP and adjust per tolerance.
- Be ready to escalate or de-escalate based on early cycles and use pre-phase steroids/vinca to reduce early complications.
Use CAR‑T For Early/Refractory Relapse
- For relapse within ~12 months or chemorefractory disease, favor CAR-T rather than more chemo and auto transplant.
- For later relapses with demonstrated chemosensitivity, consider salvage chemo and autologous transplant as reasonable options.