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Diffuse large B-cell lymphoma in the new era: prognostic tools for mapping risk
Andrea Duminuco1, Salvatore Scarso2, Vittorio Del Fabro3
1Hematology with BMT Unit, A.O.U. "G. Rodolico-San Marco", Via Santa Sofia, Catania, 78-95123, Italy. andrea.duminuco@unict.it.
Annals of Hematology
|October 20, 2025
Summary
This review highlights advanced tools beyond standard indices for diffuse large B-cell lymphoma (DLBCL) risk stratification. Integrating clinical, imaging, genetic, and molecular data improves personalized treatment strategies for better patient outcomes.
Area of Science:
- Hematology
- Oncology
- Clinical Research
Background:
- Diffuse large B-cell lymphoma (DLBCL) exhibits significant clinical and biological heterogeneity.
- While R-CHOP is standard, polatuzumab-R-CHP offers subgroup benefits, but early relapse and refractoriness remain challenges.
- Existing risk indices like IPI partially address biological complexity.
Purpose of the Study:
- To review and integrate established and emerging tools for comprehensive risk stratification in DLBCL.
- To guide risk-adapted, biologically informed treatment decisions.
- To explore prognostic and predictive markers beyond traditional clinical scores.
Main Methods:
- Literature review integrating clinical scores, geriatric models, host-status metrics, PET-derived tumor burden, immune-microenvironment signatures, and health-system markers.
- Summary of genetic predictors and dynamic molecular response via circulating tumor DNA (ctDNA).
- Appraisal of interim PET scan utility and CNS risk assessment tools.
Main Results:
- Multivariable scores, geriatric models, host metrics, PET-derived burden (TMTV, TLG), immune signatures, and diagnosis-to-treatment intervals offer refined prognostication.
- Genetic markers (CD79B/PIM1) and ctDNA response (early/major molecular response) provide dynamic molecular insights.
- Interim PET is prognostic; CD19 CAR-T therapy shows superiority in relapsed/refractory settings; CNS-IPI aids risk assessment.
Conclusions:
- Risk-adapted, biologically driven care is essential for DLBCL management.
- Incorporating NCCN-IPI, imaging burden, genomics, and ctDNA into treatment decisions improves patient stratification.
- Emerging tools enhance personalized therapeutic strategies for DLBCL patients.
