Treatment of Patients with Relapsed or Refractory Diffuse Large B-Cell Lymphoma in the Czech Republic in 2025

Abstract

Diffuse large B-cell lymphoma (DLBCL) represents a heterogeneous group of diseases within the category of non-Hodgkin lymphomas, generally associated with a relatively good prognosis. First-line treatment cures approximately 60% of patients. About 40% of patients, however, experience relapse or have primary refractory disease. The prognosis for these patients was historically very poor.

In the treatment of relapsed/refractory DLBCL, the timing of first-line treatment failure is currently a key factor. If the failure occurs within 12 months after completion of first-line therapy and the patient is eligible for CAR-T therapy, axicabtagene ciloleucel (axi-cel) or lisocabtagene maraleucel (liso-cel) should be administered. If the relapse occurs after more than 12 months and the patient is suitable for high-dose therapy, salvage immunochemotherapy followed by autologous stem cell transplantation is indicated. If the patient is not eligible for such high-dose therapy, immunochemotherapy remains the standard second-line treatment.

In third and later lines of therapy, more treatment options are now available. These include the bispecific antibody glofitamab. If the patient has not previously received CAR-T therapy, CAR-T treatment is also an option. In cases where these treatment modalities fail, loncastuximab tesirine is available in the Czech Republic for third and later lines of therapy.

Other treatment options include the bispecific antibody epcoritamab, the combination of tafasitamab + lenalidomide, or the Pola-BR regimen. However, these treatments are not currently reimbursed, and approval must be requested from the relevant health insurance company under Paragraph 16. A very promising approach is the combination of glofitamab with the GEMOx regimen for second and later lines, based on data from the STARGLO clinical trial. However, this treatment is also not yet reimbursed in the Czech Republic. Looking ahead, it is expected that these new treatment modalities will shift into earlier lines of therapy, but results from ongoing clinical trials must be awaited. Nonetheless, it can be stated that the prognosis for patients with relapsed/refractory DLBCL has significantly improved in recent years.