Treating large B-cell lymphoma: Current strategies and unmet needs across community and academic settings

Therapeutic advances in large B-cell lymphoma (LBCL) are rapidly emerging, but their development and availability are largely concentrated in academic centers. Most patients receive care within community health systems where more limited resources, infrastructure, and access to novel treatments may influence outcomes. This narrative review summarizes current treatment strategies and real-world outcomes for patients with relapsed or refractory (R/R) LBCL. Polatuzumab-based regimens remain standard for high-risk disease in the frontline setting and achieve durable responses; however, approximately 30-40% of patients experience R/R disease. While chimeric antigen receptor T-cell therapy offers curative potential, its use is constrained by logistical, socioeconomic, and geographic barriers. Novel therapies, including bispecific antibodies and antibody-drug conjugates, may improve treatment access in community settings. We also discuss patient- and practice-level factors affecting treatment strategies, unmet clinical needs, and the need for collaboration between community and academic centers in optimizing outcomes for patients with R/R LBCL.