Biomarkers and novel therapeutic approaches for diffuse large B-cell lymphoma in the era of precision medicine

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// Niraj Lodhi 1 , 2 , * , Moe Tun 2 , * , Poonam Nagpal 2 , 3 , Arati A. Inamdar 2 , Nehad M. Ayoub 4 , Noor Siyam 2 , Lucia Oton-Gonzalez 5 , Angela Gerona 2 , Dainelle Morris 2 , Rana Sandhu 2 and Kwangsun Stephen Suh 2 , 6 1 Department of Immunotherapeutic and Biotechnology, Texas Tech Health Science Center, Abilene, TX, USA 2 Formerly: The Genomics and Biomarkers Program, John Theurer Cancer Center at Hackensack University Medical Center, David Jurist Research Building, Hackensack, NJ, USA 3 College of Natural, Applied, and Health Sciences, Kean University, Union, NJ, USA 4 Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan 5 Department of Medical Sciences, University of Ferrara, Ferrara, Italy 6 DiagnoCine, Hackensack, NJ, USA * These authors contributed equally to this work Correspondence to: Kwangsun Stephen Suh, email: kstephensuh@gmail.com Keywords: DLBCL; diagnosis; R-CHOP; precision medicine; prognosis Received: June 03, 2020 Accepted: September 29, 2020 Published: November 03, 2020 Copyright: © 2020 Lodhi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. ABSTRACT Despite the great efforts for better treatment options for diffuse large B-cell lymphoma (DLBCL) (most common form of non-Hodgkin lymphoma, NHL) to treat and prevent relapse, it continues to be a challenge. Here, we present an overview of DLBCL and address the diagnostic assays and molecular techniques used in its diagnosis, role of biomarkers in detection, treatment of early and advanced stage DLBCL, and novel drug regimens. We discuss the significant biomarkers that have emerged as essential tools for stratifying patients according to risk factors and for providing insights into the use of more targeted and individualized therapeutics. We discuss techniques such as gene expression studies, including next-generation sequencing, which have enabled a more understanding of the complex pathogenesis of DLBCL and have helped determine molecular targets for novel therapeutic agents. We examine current treatment approaches, outline the findings of completed clinical trials, and provide updates for ongoing clinical trials. We highlight clinical trials relevant to the significant fraction of DLBCL patients who present with complex cases marked by high relapse rates. Supported by an increased understanding of targetable pathways in DLBCL, clinical trials involving specialized combination therapies are bringing us within reach the promise of an effective cure to DLBCL using precision medicine. Optimization of therapy remains a crucial objective, with the end goal being a balance between high survival rates through targeted and personalized treatment while reducing adverse effects in DLBCL patients of all subsets.

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