弥漫性大B细胞淋巴瘤（DLBCL）的大多数患者通过前线化疗免疫疗法可以治愈，但有30％-40％的患者会出现复发性疾病。历史上，规避化疗难度的救治方案是经过与自体干细胞移植（ASCT）的方案。然而，研究表明，原发性难治或早期复发（R / R;高风险）DLBCL患者 ASCT 是无益的，促进了对其他选择的研究。随着嵌合抗原受体（CAR）T细胞疗法的出现，R / R DLBCL的治疗发生了巨大变化。 TRANSFORM 和 ZUMA-7 试验的积极结果和可控毒副作用，批准了利索卡布他吉康（liso-cel）和阿席卡布他吉康（axi-cel）作为高风险 R / R DLBCL 的二线治疗。但是，这些试验要求患者对ASCT的体质适宜。在PILOT研究中，已被认为liso-cel是一个合理的治疗选择，适用于不能接受移植的R / R患者。我们建议对于高风险 R / R DLBCL的体质适宜的患者使用axi-cel或liso-cel，对于不适宜移植的R / R患者使用liso-cel作为二线治疗。如果CAR-T细胞疗法不可行，我们建议对于化疗敏感的患者考虑ASCT，健康的或处于临床试验中的患者，如果患者处于不适宜或化疗无应答阶段，则建议考虑临床试验。如果临床试验也不是最佳选择，则有可替代的治疗方案。随着双特异性T细胞诱导抗体等新治疗方案的出现，R / R DLBCL 的治疗形式可能会改变。在R / R DLBCL患者管理方面仍存在许多未解决的问题，但是鉴于细胞疗法的前景，这一患者群体历史上令人失望的生存率也变得更具乐观。

Most patients with diffuse large B-cell lymphoma (DLBCL) will be cured with up-front chemoimmunotherapy, but 30%-40% of patients will experience relapsed disease. Historically, salvage chemotherapy followed by autologous stem-cell transplant (ASCT) was the mainstay of treatment for these patients. However, research has demonstrated that patients with primary refractory or early relapsed (R/R; high-risk) DLBCL do not benefit from ASCT, prompting investigation into other options. With the advent of chimeric antigen receptor (CAR) T-cell therapy, treatment of R/R DLBCL has changed dramatically. With positive outcomes in the TRANSFORM and ZUMA-7 trials with manageable toxicity profiles, approval was obtained for lisocabtagene maraleucel (liso-cel) and axicabtagene ciloleucel (axi-cel) as second-line therapies for high-risk R/R DLBCL. However, these trials required patients to be medically fit for ASCT. In PILOT, liso-cel was deemed a reasonable treatment option for R/R transplant-ineligible patients. We recommend either axi-cel or liso-cel for fit patients with high-risk R/R DLBCL or liso-cel for unfit R/R patients as a second-line therapy. If CAR T-cell therapy is not an option, we recommend consideration of either ASCT if the patient has chemosensitive disease and is fit or clinical trial if the patient is unfit or has chemoresistant disease. If trials are not an option, alternative treatments are available. With the advent of additional therapies such as bispecific T-cell-engaging antibodies, the treatment landscape of R/R DLBCL may be upended. There continue to be many unanswered questions in the management of patients with R/R DLBCL, but given the promise of cellular therapies, outcomes are more optimistic in this group with historically dismal survival.