title: New developments in the management of diffuse large B-cell lymphoma.
abstract: Diffuse large B-cell lymphoma is the most common adult non-Hodgkin lymphoma and is potentially curable. Immunochemotherapy, R-CHOP (rituximab, cyclophosphamide, adriamycin, vincristine, and prednisone) is the standard of care. This regimen has been incorporated in  other approaches and reevaluated in different trials in different age groups. The duration of cycle therapy has varied from 14 to 21 days. In addition, R-ACVBP has been evaluated in randomized trials. Autologous stem cell transplantation (ASCT) has been evaluated in randomized clinical trials.  Ongoing studies are evaluating new regimens such as EPOCH-R and novel maintenance therapy approaches in the upfront management of DLBCL. In the relapse and refractory setting, autologous stem cell transplantation remains the standard of care with treatment with R-ICE or R-DHAP followed by  different conditioning regimens prior to ASCT. The outcomes of patients who relapse following ASCT are improving with the treatment of new agents targeting different pathways such as lenalidomide. New monoclonal antibodies are under evaluation. The Bruton s tyrosine kinase inhibitor is in  early stages of development. Targeted therapy has changed the natural history of diffuse large B-cell lymphoma. Past microarray and new DLBCL hypersequencing data are revealing new pathways and targets to further explore therapeutically. This review will describe the contribution of immunochemotherapy  and other interventions in diffuse large B-cell lymphoma evaluating past clinical trials, review early clinical trial observations, and discuss current future directions.
authors.affiliation: Mayo Clinic, Rochester, MN 55905, USA. habermann.thomas@mayo.edu
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Habermann
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D006801:Humans; D007167:Immunotherapy; D000077269:Lenalidomide; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000628:therapy*; D011241:Prednisone / Q000627:therapeutic use; D000069283:Rituximab; D055502:Secondary Prevention; D033581:Stem Cell Transplantation; D013792:Thalidomide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014750:Vincristine / Q000627:therapeutic use; D014751:Vindesine / Q000627:therapeutic use
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; C571759:R-CHOP protocol; D001761:Bleomycin; D000069283:Rituximab; D013792:Thalidomide; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D000077269:Lenalidomide; D014751:Vindesine; D011241:Prednisone