Download PDF
CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2019; 40(04): 463-464
DOI: 10.4103/ijmpo.ijmpo_211_19
Editorial Commentary

Personalized Medicine in Diffuse Large B-Cell Lymphoma

Prashant Mehta
Department of Medical Oncology, Hematology and BMT, Asian Institute of Medical Sciences, Faridabad
,
Rahul Bhargava
Department of Medical Oncology, Hematology and BMT, Asian Institute of Medical Sciences, Faridabad
› Author Affiliations Financial support and sponsorship Nil.
› Further Information
   Permissions and Reprints

Diffuse large B-cell lymphoma (DLBCL) forms about 40% of non-Hodgkin’s lymphomas in clinical practice; though it is curable with chemoimmunotherapy, those who fail R-CHOP have a dismal outcome. It is a heterogeneous disease in terms of biology and prognosis, with 3-year progression-free survival (PFS) of activated B-cell (ABC) versus germinal centre B-cell (GCB) type being 40% versus 75%.

Dr. Alizadeh et al. first threw light upon the molecular subtypes via their LLMP Project where they brought out the biological and prognostic differences among DLBCL subtypes; their work was published in Nature in January 2000.

Randomized studies utilizing the biological and molecular differences between the two subtypes have thereafter been done and reported PHOENIX (ibrutinib ± R-CHOP), ROBUST (lenalidomide ± R-CHOP), REMoDL-B (bortezomib ± R-CHOP), GOYA (R-CHOP vs. G-CHOP, obinutuzumab), and CALGB/ALLIANCE 50303 (R-CHOP vs. DA-EPOCH R), but none of these found a survival advantage of any of these strategies when tested without regard to specific molecular alterations, except a subset analysis of PHOENIX in patients aged <60 years. These studies undermined the very principle of personalized medicine, which looks at each patient as a distinct entity. In fact, it may be extremely difficult to elucidate the virtues of personalized precision medicine in a randomized manner unless only a specific molecular alteration is evaluated one at a time, instead of a large subgroup with so much heterogeneity within itself.

We look at some of the important molecular alterations in DLBCL and their utility in personalized medicine which may alter the treatment landscape of DLBCL.



Publication History

Received: 15 October 2019

Accepted: 12 January 2020

Article published online:
03 June 2021

© 2020. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India