[What is established in the treatment of diffuse large B-cell lymphoma?]

Diffuse large B‑cell lymphoma (DLBCL) is the most common aggressive non-Hodgkin lymphoma, with a median age at diagnosis of 71 years, predominantly affecting older adults. Risk factors include immunodeficiency, autoimmune disorders, viral infections, and certain environmental exposures, although most cases lack a clear predisposition. Diagnosis is based on lymph node excision, histopathological and molecular analysis, and positron emission tomography-computed tomography (PET-CT) staging. First-line standard therapy is R‑CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), de-escalated to four cycles for young, low-risk patients (FLYER trial). For patients with International Prognostic Index (IPI) ≥ 2, the POLARIX trial showed superior progression-free survival with polatuzumab vedotin-R-CHP (rituximab, cyclophosphamide, doxorubicin, prednisone) over R‑CHOP. Older patients are generally treated with dose-reduced R‑mini-CHOP or alternatives. In relapsed/refractory disease, chimeric antigen receptor (CAR) T‑cell therapy with axicabtagene ciloleucel or lisocabtagene maraleucel has replaced high-dose chemotherapy with autologous stem cell transplantation for refractory or early relapses, including transplant-ineligible patients. Additional antibody-based therapies-such as polatuzumab-bendamustine-rituximab, tafasitamab-lenalidomide, loncastuximab, and bispecific antibodies (glofitamab, epcoritamab, odronextamab)-expand treatment options, some achieving durable remissions. Glofitamab plus gemcitabine-oxaliplatin is a new standard for first relapse when CAR T‑cell therapy is not feasible or as bridging before CAR T. Future directions include earlier integration of immunotherapies, personalized strategies guided by genetic subgroups, and broader use of liquid biopsy for subtyping, minimal residual disease detection, and treatment guidance.