Improving Cure Rates for Patients with Newly Diagnosed Large B-Cell Lymphomas: Targeted Therapies for High-Risk Pathologic Subgroups as Defined by Clinical Laboratory Testing.

Simple Summary: While many patients diagnosed with large B cell lymphomas (LBCL), specifically diffuse large B cell lymphoma (DLBCL) will be cured following treatment with first-line immunochemotherapy, those who are not are likely to die from complications of this disease. This discrepancy in outcome suggests biologic heterogeneity of this common lymphoid malignancy, and LBCL tumors can be both classified and risk-stratified by testing available in the clinical laboratory. Such testing may also identify opportunities to add targeted agents to first-line immunochemotherapy in homes of improving survival for patients whose tumors harbor high-risk pathologic features, examples of which are offered. Whether more complex comprehensive genomic analyses can be applied in clinical practice and enhance this effort remains to be determined. Background/Objectives: Diffuse large B-cell lymphoma (DLBCL) and high-grade B cell lymphoma (HGBL) comprise the majority of large B-cell lymphomas (LBCL), and approximately two-thirds of patients diagnosed with these LBCLs are cured following treatment with first-line immunochemotherapy. While the International Prognostic Index (IPI) score is a validated prognostic tool used for patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), there is a growing body of evidence that suggests that LBCL tumor features, which can be detected by clinical laboratory testing, can predict patient survival following first-line immunochemotherapy. Conclusions: Clinical laboratory testing may also allow for rational identification of targeted agents that can be added to first-line immunochemotherapy for high-risk, pathologically defined subsets of LBCL patients, and this approach may result in better survival outcomes for the entire LBCL patient population as compared with adding pathologically "agnostic" agents for those defined as high risk by IPI score. [ABSTRACT FROM AUTHOR]