Contemporary management of diffuse large B-cell lymphoma in Japan.

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.