[Current diagnostic and therapeutic standards in aggressive B-cell lymphomas]

In this review, we focus on new advances regarding diagnostic and therapeutic standards of aggressive B-cell lymphomas. This includes the introduction of the so-called "cell of origin" classification which differentiates diffuse large B-cell lymphomas (DLBCL) into the ABC and GCB subtypes and became part of the revised WHO classification of 2017. While 6-8 cycles of R-CHOP remain the standard of first-line treatment in DLBCL, for young patients up to 60 years of age with an international prognostic index (IPI) of 0 the treatment can be shortened to 4 cycles of R-CHOP plus 2 cycles of rituximab.With regard to the prophylaxis of CNS relapse, the so-called CNS-IPI helps to identify patients with high risk of relapse in the CNS even if data from randomized clinical trials is sparse. For those patients, 2 courses of high-dose methotrexate in addition to first-line treatment seem advisable.For patients with relapse or refractory disease, salvage treatment followed by autologous or allogeneic transplantation remains the standard. After failure of 2 lines of treatment, 2 different CAR-T-cell products are licensed offering a potentially curative treatment options even for patients not eligible for transplantation strategies. New treatment modalities as antibody-drug conjugates and bispecific antibodies show promising results in clinical studies and will presumably broaden the spectrum of treatment options for patients with DLBCL.