title: Treatment approaches of hard-to-treat non-Hodgkin lymphomas.
abstract: Even after recent advancements with monoclonal antibodies, antibody drug conjugates and immune therapies, relapsed and refractory lymphomas remain challenging to treat; and the definition and treatment approaches of hard-to-treat lymphomas (HTL) continue to evolve. Areas covered: In this review, we will address HTL encompassing diffuse large B cell lymphoma (DLBCL), follicular lymphoma (FL) and peripheral T cell lymphomas (PTCL). DLBCL, which comprises 30-40% of non-Hodgkin lymphomas is a highly aggressive and heterogeneous malignancy, with primary refractory or relapsed disease remaining a therapeutic challenge. Similarly, early relapse within 2 years of primary treatment in the more indolent FL is associated with inferior outcomes. Finally, PTCL are universally aggressive and carry a poor prognosis. Expert commentary: Recently, novel antibodies, antibody drug conjugates, immunotherapies and cellular therapy (CAR therapy) have shown promising results in early phase clinical trials. These agents are changing the landscape of treatment of lymphomas and will be extremely important for improving outcomes of HTL. Importantly, revising current strict eligibility criteria for clinical trial participation is needed to help these patients benefit from these novel agents.
authors.affiliation: a Hematology & Oncology , University of Alabama at Birmingham , Birmingham , AL , USA.
authors.forename: Lakshminarayanan
authors.initials: L
authors.lastname: Nandagopal
authors.affiliation: b Hematology & Oncology, Department of Medicine , University of Alabama at Birmingham , Birmingham , AL , USA.
authors.forename: Amitkumar
authors.initials: A
authors.lastname: Mehta
mesh_terms: D000465:Algorithms; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D019468:Disease Management; D019008:Drug Resistance, Neoplasm; D019254:Genes, bcl-2; D016259:Genes, myc; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis / Q000235:genetics / Q000628:therapy*; D058990:Molecular Targeted Therapy; D051560:Proto-Oncogene Proteins c-bcl-6 / Q000235:genetics; D012008:Recurrence; D019233:Retreatment; D016896:Treatment Outcome
chemical_list: D051560:Proto-Oncogene Proteins c-bcl-6
keywords: NHL; double hit; lymphomas; refractory; relapsed