Competitive Treatment in Diffuse Large B-Cell Lymphoma (DLBCL): Expanded 2025 Review

Abstract Diffuse Large B-Cell Lymphoma (DLBCL) remains the most common aggressive B-cell malignancy worldwide, accounting for 30–35% of non-Hodgkin lymphomas. This expanded 2025 review examines modern frontline standards including polatuzumab vedotin-based regimens, emerging therapeutics, antibody-drug conjugates, CAR-T cell therapies, and bispecific antibodies. We synthesize molecular risk stratification through genomic clustering, TP53 mutations, and circulating tumor DNA monitoring, alongside AI-driven prognostics and evolving global clinical guidelines. The manuscript integrates mechanistic insights, pivotal clinical trial outcomes (POLARIX, ZUMA-7, TRANSFORM), real-world evidence, and future precision medicine directions. Key advances include pola-R-CHP as new frontline standard, CAR-T as preferred second-line therapy for early relapse, and bispecific antibodies dominating post-CAR-T management, collectively transforming the competitive DLBCL treatment landscape while highlighting persistent global access disparities requiring urgent attention