Diffuse Large B-Cell Lymphoma’s New Genomics: The Bridge and the Chasm
Cet article présente les nouvelles catégories génomiques proposées récemment pour les lymphomes diffus à grandes cellules B puis analyse le potentiel de ces nouvelles catégories pour personnaliser les traitements
The clinical and molecular heterogeneity of diffuse large B-cell lymphoma (DLBCL), even beyond the recent WHO reclassification,1 is well recognized. (For simplicity, this review will still use the term DLBCL to cover all the related WHO entities, including high-grade B-cell lymphoma [HGBL].) Yet, efforts to individualize therapy on the basis of this recognition have thus far been met with limited success.2,3 Why this may be, and why this may soon change, is the topic of this review. Recent comprehensive multiplatform genomic analyses have deeply probed and systematically organized the heterogeneity of DLBCL. This new knowledge could facilitate a major paradigm shift in DLBCL, which would finally allow for the successful deployment of precision medicine–based approaches. The goal is clear, and we now have new tools to build a bridge to it. Yet, the chasm that remains is wide, and successfully bridging it will require much foresight and collaboration. Here, we examine the foundation for the traditional classification tools that remain in use today and review the major efforts to personalize therapy on the basis of them. We briefly describe the new genomic categories, highlighting both their potential to profoundly transform the approach to DLBCL treatment and the significant challenges this will entail.
Journal of Clinical Oncology , article en libre accès, 2019