Therapeutic landscape of primary refractory and relapsed diffuse large B-cell lymphoma: Recent advances and emerging therapies

Diffuse large B-cell lymphoma (DLBCL) is an aggressive, yet curable malignancy, that has had practice changing treatment approvals in both the frontline and relapsed setting in the last 5 years. Advent of novel therapeutic options in the recent years has added greater complexity in treatment selection and optimal sequencing given multiple treatments with the same therapeutic target or immunotherapeutic mechanism of action. Key features impacting treatment selection include the timing of relapse, eligibility for curative options in the second line setting, including chimeric antigen receptor T-cell therapy (CAR-T) and autologous stem cell transplant (auto-SCT), as well as considerations of mechanism of action and side effect profile. This article provides a comprehensive review on recently approved therapies for relapsed or refractory DLBCL, emerging cellular and non-cellular therapies, and a summary of our approach to the management of these patients.