Managing early failures with R-CHOP in patients with diffuse large B-cell lymphoma

Patients with refractory or relapsing diffuse large B-cell lymphoma (DLBCL) represent a major challenge for physicians, and the tools necessary to manage these situations remain limited and better options are needed. Despite the overall improvement in the outcome of patients with DLBCL since the introduction of front-line immunochemotherapy (R-CHOP), 20% of patients are primarily refractory or experience short-term relapse and have an extremely poor prognosis. Areas covered: This article reviews the current landscape of refractory/relapsed DLBCL management solutions, including chemotherapy and targeted therapies, with a special focus on primary refractory patients. We performed a literature search using PUBMED to find recent major publications establishing how to best determine the optimal treatment for these patients with regard to recent advances and emerging therapies. Expert commentary: High-dose chemotherapy (HDC) followed by autologous hematopoietic stem cell transplantation (ASCT) can provide durable disease control in this situation regardless of the timing of the relapse and represents the standard of care after R-CHOP failure for 'fit' patients less than 70 years of age.