Oncology Brothers: Practice-Changing Cancer Discussions How to Treat Diffuse Large B-Cell Lymphoma (DLBCL) in 2025
Jul 17, 2025
In this discussion, esteemed lymphoma expert Dr. John Leonard from NYU Langone Cancer Center delves into the complexities of treating diffuse large B-cell lymphoma (DLBCL). He highlights the evolving management strategies, particularly the promising Pola-R-CHP regimen and its implications for Stage 1 and 2 diseases. Dr. Leonard also explores the emerging options for relapsed cases, including CAR-T therapy and bispecific antibodies, while emphasizing the importance of tailoring treatments for various patient profiles.
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Prefer PET And Good Biopsy Over Routine Marrow
- Do get a high-quality excisional or core biopsy and PET-CT for staging rather than relying on FNA or routine marrow biopsies.
- Avoid routine bone marrow biopsy because PET-negative responses usually reflect marrow response and it rarely changes management.
Genomics Lagging In Actionable Targets
- Molecular profiling and mutational analyses are increasingly performed but have limited actionable impact today.
- John Leonard notes that genomic insights lag behind solid tumors for directing targeted therapy in DLBCL.
Use PET-Adaptive Treatment For Limited Stage
- Use a PET-adapted approach in limited-stage DLBCL and consider abbreviated therapy when PET-negative after three cycles.
- If PET-positive after three cycles, escalate treatment with radiation and/or more chemo rather than abbreviating.