[Comment] Moving beyond R-CHOP in large B-cell lymphoma

Outcomes for patients with high-risk large B-cell lymphoma (LBCL) remain unsatisfactory. These patients are defined by an International Prognostic Index (IPI) score of 3-5. Despite substantial progress in understanding the biology and molecular heterogeneity of LBCL, R-CHOP treatment has remained the standard first-line therapy for over two decades. R-CHOP is a combination of rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone or prednisolone. This treatment achieves durable remissions in approximately 60% of patients. Multiple strategies aimed at improving outcomes, such as chemotherapy intensification, alternative anti-CD20 antibodies, or the addition of targeted agents to R-CHOP, have generally failed to improve survival.