CELL INTELLIGENCE · 肿瘤细胞治疗研究

INTRODUCTION: Despite the heterogeneity of diffuse large B-cell lymphoma (DLBCL), treatment approaches are remarkably well-standardized. However, its management differs according to socio-economic and medical environments. AREAS COVERED: This review analyzed the latest trends in DLBCL diagnosis and treatment in Japan, where the national universal healthcare insurance covers the cost of novel modalities, such as polatuzumab vedotin, chimeric antigen receptor T cells (CAR-T), or bispecific antibodies (BsAb). Given the particularly high incidence, we spotlighted DLBCL in older adults. CD5-positive (CD5+) DLBCL and intravascular large B-cell lymphoma (IVLBCL) were also discussed based on the leading trials conducted in Japan. EXPERT OPINION: The accurate pathologic diagnosis of DLBCL made by experts or via consultation networks is essential, and an emerging genomic assay will contribute to future precision approaches. Although polatuzumab vedotin is frequently used in the first-line treatment of patients with advanced disease, its application should be carefully analyzed. As the number of older patients increases, the importance of pre-treatment geriatric assessment becomes apparent. CD5+ DLBCL and IVLBCL adopt distinct strategies with high-dose methotrexate, but their benefits warrant further evaluation. CAR-T and BsAb are increasingly used to treat patients with relapsed and refractory diseases. A cost-effective evaluation of these novel approaches is required. Diffuse large B-cell lymphoma (DLBCL) is the most frequent subtype of hematologic cancer. Due to its commonness, treatment is standardized globally. However, everyday patient care of DLBCL can differ from country to country. This review highlights the modern management of DLBCL in Japan, where the national universal healthcare plan supports the use of expensive novel medicines. The first step is to accurately diagnose DLBCL by expert pathologists or via consultation networks. A developing genomic assay is expected to promote future personalized care of DLBCL in Japan. Polatuzumab vedotin is a recently approved medicine for the first-line treatment of DLBCL and is widely used in Japan, but its application should be carefully discussed. Geriatric assessment before the treatment becomes more important since Japan is the most advanced aging society. CD5-positive DLBCL and intravascular large B-cell lymphoma have special characteristics, and Japanese physicians approach these subtypes differently based on the results from their clinical studies. Chimeric antigen receptor T cells or bispecific antibodies are more often used for relapsed or refractory patients with DLBCL in Japan, but their cost-effectiveness should be further considered.