DLBCL TREATMENT IN CHINA —
FIRST AND SECOND LINE OPTIONS

DLBCL is an aggressive B-cell non-Hodgkin lymphoma that grows quickly but is often very responsive to treatment. Modern classification recognises several biological subtypes — germinal centre B-cell (GCB) and activated B-cell (ABC) being the most established — that have different prognostic and therapeutic implications. High-grade B-cell lymphomas with MYC and BCL2 and/or BCL6 rearrangements (so-called double-hit and triple-hit lymphomas) are biologically distinct and need more intensive treatment. Risk is assessed using the International Prognostic Index (IPI), which combines age, stage, performance status, LDH level, and number of extranodal sites. Diagnostic workup includes lymph node biopsy with full immunohistochemistry, FISH for MYC, BCL2, and BCL6 rearrangements, PET CT, bone marrow biopsy, hepatitis B/C and HIV screening, and cardiac assessment. A complete pathology review is the foundation of every treatment decision.

R-CHOP — The Standard Backbone R-CHOP — rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone — given every three weeks for six cycles, remains the most widely used first-line regimen for DLBCL globally and in China. About two-thirds of patients are cured with this regimen alone. Pre-treatment cardiac assessment and hepatitis screening are essential because of doxorubicin's cardiotoxicity and the rituximab risk of hepatitis B reactivation. Pola-R-CHP for Higher-Risk Patients Polatuzumab vedotin combined with rituximab, cyclophosphamide, doxorubicin, and prednisone (Pola-R-CHP) — replacing vincristine with polatuzumab — has become a standard option for selected higher-risk DLBCL based on the POLARIX trial. It is used in patients with intermediate-to-high IPI, often those aged 60 to 80, who can tolerate intensive therapy. Availability and reimbursement vary by country and by Chinese centre. More Intensive Regimens for Double-Hit and CNS-Risk Disease Patients with high-grade B-cell lymphoma carrying double-hit or triple-hit translocations are often treated with more intensive regimens such as DA-EPOCH-R (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab). Patients with high CNS relapse risk may receive intrathecal methotrexate or systemic high-dose methotrexate as CNS prophylaxis. Older or Unfit Patients Older or frail patients may receive R-mini-CHOP, R-bendamustine, or R-GemOx, balancing efficacy with tolerability. The right choice depends on age, performance status, comorbidities, and patient preference. China has strong experience in geriatric oncology, and several major centres run dedicated lymphoma protocols for older patients.

Response is assessed with PET CT, usually mid-treatment and at the end of therapy, using the Deauville five-point scale. Achieving a complete metabolic response at the end of first-line therapy is associated with the highest chance of durable cure. Maintenance therapy is generally not used in DLBCL after first line, in contrast with follicular and other indolent lymphomas. Surveillance after treatment relies on clinical follow-up, blood tests, and imaging at defined intervals, with PET CT used selectively when relapse is suspected.

Around 30–40 per cent of DLBCL patients relapse after first-line therapy. The second-line landscape has shifted substantially over the past few years, with CAR-T therapy now used earlier, particularly in primary refractory disease and early relapse. CAR-T Cell Therapy CD19-targeted CAR-T is now standard second-line treatment for patients with primary refractory DLBCL or relapse within 12 months of first-line therapy, replacing the older salvage-and-transplant approach in many cases. Approved CAR-T products include axicabtagene ciloleucel and lisocabtagene maraleucel internationally, with relmacabtagene autoleucel (relma-cel) and other domestic Chinese products available in China at lower cost. Early CAR-T access is one of the strongest reasons international patients consider China. Autologous Stem Cell Transplant For patients with later relapse or chemo-sensitive disease who can achieve a second remission with salvage chemotherapy (such as R-DHAP, R-ICE, or R-GDP), high-dose chemotherapy followed by autologous stem cell transplant remains a curative option in selected cases. Choosing between CAR-T and autologous transplant depends on time to relapse, response to salvage chemotherapy, fitness, and centre experience. Bispecific Antibodies and Other Options CD20×CD3 bispecific antibodies — glofitamab and epcoritamab — are now approved for relapsed DLBCL after multiple lines and are increasingly used in patients who are not CAR-T candidates or who relapse after CAR-T. Polatuzumab vedotin combined with bendamustine and rituximab (Pola-BR) is another active second-line option. Tafasitamab plus lenalidomide and loncastuximab tesirine are additional approved choices in selected settings. Selinexor is approved in heavily pre-treated disease. Trial-based options in China include CD19/CD22 bispecific CAR-T, allogeneic CAR-T, and novel checkpoint or antibody-drug conjugate combinations. Allogeneic Stem Cell Transplant Allogeneic stem cell transplant remains an option for selected younger patients with relapsed disease after CAR-T, autologous transplant, or in trial-based combination strategies. China's leadership in haploidentical transplant makes this pathway practical for patients without matched donors.

CancerFax supports DLBCL patients exploring care in China through a structured pathway:

• Case review — diagnosis, subtype, IPI, prior therapy, and cu

  Case review — diagnosis, subtype, IPI, prior therapy, and current status are reviewed to clarify what options are realistic — first-line, second-line, CAR-T, or transplant.

• Treatment and trial mapping — appropriate regimens, CAR-T pr

  Treatment and trial mapping — appropriate regimens, CAR-T products, bispecific antibodies, transplant pathways, and clinical trials are identified across major Chinese centres.

• Hospital matching — reports are shared with appropriate haem

  Hospital matching — reports are shared with appropriate haematology and cell therapy teams for structured feedback.

• Cost and logistics planning — patients receive guidance on r

  Cost and logistics planning — patients receive guidance on regimen choice, expected length of stay, ICU and infection management, blood product use, and accommodation.

• Coordination and follow-up — CancerFax supports admission, i

  Coordination and follow-up — CancerFax supports admission, interpreter needs, monitoring schedules, and continuity with the local team after returning home.

DLBCL care in China is delivered across major university and government hospitals in cities such as Beijing, Tianjin, Shanghai, Suzhou, Guangzhou, Hangzhou, and others. Centres differ in CAR-T product availability (approved versus trial), bispecific antibody experience, transplant capacity, paediatric or adult focus, and trial activity in next-generation platforms. The same patient may face different eligibility rules, admission timelines, and cost structures depending on the centre. CancerFax helps patients identify the most appropriate pathway based on disease, prior treatment, and intended therapy line — rather than choosing a hospital by name alone.

Frequently Asked Questions

Answers to common questions from patients and families.