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Diffuse large B-cell lymphoma: update on therapy and prognosis

Manuel Gotti, Valeria Fiaccadori, Ercole Brusamolino

The introduction of rituximab in combination with chemotherapy has substantially changed the outcome of patients with diffuse large B-cell lymphoma. This update will discuss the factors that improved our predictive capacity in these lymphomas and the results obtained by large clinical trials in first-line and salvage therapy. As far as first-line therapy is concerned, mature data are available for low-risk patients younger than 60 and for elderly patients; for patients older than 60 with unfavorable risk factors, conclusive data are still pending. Despite major advances in the first-line therapy, approximately half of the patients with diffuse large B-cell lymphoma experience treatment failure or refractoriness to first-line therapy. The standard therapy in these patients is high-dose chemotherapy followed by peripheral stem cell transplantation as hematologic rescue. Prior rituximab, as part of first-line therapy, does adversely influence the outcome of salvage therapy. New molecules and antibodies are being investigated in Phase I/II studies in patients who have relapsed or exhibit primary refractoriness and in those not eligible for peripheral stem cell transplantation. The new perspectives with these agents will be discussed.