The Evolving Landscape of DLBCL Treatment Beyond the First Line in 2024

The landscape for treating relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL) in 2024 is rapidly evolving, with various treatment options emerging. Traditionally, salvage chemotherapy followed by autologous stem cell transplant (ASCT) has been the primary treatment for young, fit patients with R/R DLBCL, and only limited options exist for those ineligible for transplant. However, recent research and regulatory approvals, such as chimeric antigen receptor (CAR) T-cell and bispecific antibody therapies, have significantly improved our ability to treat patients previously considered palliative for R/R DLBCL. Moreover, further research has demonstrated that these advanced technologies are not only effective in the transplant setting but also in individuals who are not traditionally eligible for ASCT and those with comorbid conditions. One anticipated development has been the provincial approvals of bispecific T-cell engagers (BiTEs), such as epcoritamab and glofitamab, which target CD20 and CD3. BiTE therapy holds promise as an off-the-shelf treatment option, potentially offering wider availability to patients compared to CAR T-celll therapy or even post‑CAR T-cell failure.