Front-line DLBCL Therapies in Canada in 2026: Biology Matters

Abstract

Diffuse large B-cell lymphoma (DLBCL) is an aggressive lymphoma responsible for 30–40% of adult non-Hodgkin lymphoma cases. It can develop on its own or from indolent lymphoma.1-2 R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) has been the front-line standard therapy choice since 2002, but about 20% of patients do not achieve a complete response, and 20–30% experience relapse.3-4 While the International Prognostic Index (IPI) helps predict outcomes, certain biological features can signal a higher risk of treatment failure.5 Historically, adding targeted therapies to R-CHOP has not improved outcomes. Recently, two phase III trials, POLARIX (targeting CD79b) and FRONTMIND (targeting CD19), showed improved progression-free survival (PFS) over R-CHOP. This review summarizes current front-line DLBCL therapy, emphasizing how biology can guide treatment choices.