Abstract：
Diffuse large B-cell lymphoma (DLBCL) is the most frequent aggressive lymphoma seen in clinical practice. Despite huge strides in understanding its biology, front-line therapy has remained unchanged for decades. Roughly one-third of patients have primary refractory or relapse following the end of conventional first-line therapy. The outcome of patients with primary refractory disease and those with early relapse (defined as relapse less than 1 year from the end of therapy) is markedly inferior to those with later relapse and is exemplified by dismal overall survival. In this article, the authors term patients with features that identify them as being at particularly high-risk for either primary refractory disease or early relapse, as \'ultra-high-risk\'. As new treatment options become established (e.g. bispecific T-cell engagers, chimeric antigen receptor \'CAR\' T-cells and antibody-drug conjugates), it is likely that there will be a push to incorporate some of these agents into the first-line setting for patients identified as ultra-high-risk. In this review, the authors outline advances in positron emission tomography, widely available laboratory assays and clinical prognosticators, which can detect a high proportion of patients with ultra-high-risk disease. Since these approaches are pragmatic and able to be adopted widely, they could be incorporated into routine clinical practice.
摘要：
弥漫性大B细胞淋巴瘤（DLBCL）是临床实践中最常见的侵袭性淋巴瘤。尽管在理解它的生物学方面取得了巨大的进步，一线治疗几十年来一直保持不变。大约三分之一的患者在常规一线治疗结束后出现原发性难治性或复发。原发性难治性疾病患者和早期复发患者（定义为从治疗结束后不到1年的复发）的预后明显低于晚期复发患者，并且总体生存率不佳。在这篇文章中,作者将患者的特征确定为原发性难治性疾病或早期复发的风险特别高，作为“超高风险”。随着新的治疗选择的建立(例如双特异性T细胞衔接者，嵌合抗原受体\'CAR\'T细胞和抗体-药物缀合物)，很可能会推动将这些药物中的一些药物纳入被确定为超高风险患者的一线治疗方案.在这次审查中,作者概述了正电子发射断层扫描的进展，广泛可用的实验室化验和临床预测，可以检测出高比例的超高危患者。由于这些方法是务实的，能够被广泛采用，它们可以纳入常规临床实践。
