Treatment approach to newly diagnosed diffuse large B-cell lymphoma

Diffuse large B-cell lymphoma (DLBCL) is the most frequent subtype of non-Hodgkin lymphoma in western countries. High prognostic heterogeneity is observed among patients with DLBCL with long-term survival ranging from 30% to more than 90% according to clinic-biological prognostics such as the International Prognostic Index (IPI) and its subsequent revised variants. Recent advances in the understanding of DLBCL biology as cell-of-origin (COO) determination has led to significant improvement of prognostic tools but also shed light on new potential targeted compounds for specific DLBCL subtypes. First DLBCL subset has been designed germinal center B-cell like DLBCL (GCB) because it expresses genes characteristic of germinal center B cells. Second DLBCL subset has been designed activated B-cell like DLBCL (ABC) because it expresses genes upregulated in response to in vitro activation. In this review, we will present state-of-the-art treatment of DLBCL in young and elderly patients, recent results in dose-dense regimen as well as potential interest for high-dose therapy followed by autologous stem cell transplant. A special emphasis will be given to new treatment developments according to COO in DLBCL. In particular, we will focus on new drugs that might alleviate the worse prognosis associated to DLBCL ABC subtype in the near future.