Immunotherapy for Paediatric Diffuse Large B-Cell Lymphoma: A Review of Current Clinical Trials and Future Directions

Cancer research · Diffuse large B-cell lymphoma

Waldenström Macroglobulinemia (WM) is distinguished from other indolent lymphomas

Diffuse large B‑cell lymphoma (DLBCL) is the most common type of non‑Hodgkin lymphoma. Approximately 30% to 40% of patients will develop relapsed/refractory (R/R) DLBCL, leading to significant morbidity and mortality. Salvage chemoimmunotherapy followed by high‑dose chemotherapy and autologous stem cell rescue (HDT‑ASCR) is the standard of care for chemosensitive and transplant‑eligible R/R DLBCL. In patients who are ineligible for HDT‑ASCR or who fail HDT‑ASCR, treatment is mostly with palliative intent. But the recent advances with chimeric antigen receptor T‑cell (CAR‑T) therapy and several FDA‑approved targeted agents are changing the current landscape of R/R DLBCL management. There is no one‑size‑fits‑all approach, and guidance regarding optimal sequencing of subsequent therapies is an unmet need. This review highlights the approved CAR‑T constructs, including their efficacy, adverse effects, and real‑world data; bridging therapy to CAR‑T; the role of emerging targeted agents, including bispecific antibodies; and the timing of these targeted agents in relation to CAR‑T therapy. Providing individualized treatment with thoughtful sequencing of available agents is essential until future prospective randomized clinical trials provide more insights.

Approximately 30–40% of patients will develop relapsed/refractory DLBCL, leading to significant morbidity and mortality.

Evidence level: Klinikai vizsgálat. Formális klinikai vizsgálati eredmény.

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