At the 67th Annual Meeting of the American Society of Hematology (ASH), Prof. Ou Bai and her team from The First Hospital of Jilin University presented multiple impactful studies. Two key works focused respectively on treatment optimization for primary central nervous system diffuse large B-cell lymphoma (PCNS-DLBCL) and on the prognostic impact and management of viral infections in DLBCL. Hematology Frontier invited Prof. Bai for an in-depth on-site interpretation to translate these findings into actionable clinical insights.Optimizing PCNS-DLBCL Treatment
R-MT Induction and the Role of Consolidation or Maintenance Therapy
At ASH 2025, Prof. Bai’s team reported favorable outcomes using rituximab plus high-dose methotrexate and thiotepa (R-MT) as first-line induction therapy for PCNS-DLBCL (Abstract No. 5475). Prof. Bai further elaborated on patient selection, treatment sequencing, and the prognostic value of consolidation or maintenance strategies.
Prof. Ou Bai
Primary CNS lymphoma is dominated pathologically by DLBCL. High-dose methotrexate–based regimens remain the cornerstone of therapy and can achieve meaningful responses.
Our real-world data indicate that after induction with high-dose methotrexate combined with thiotepa, patients who subsequently receive consolidation—either autologous stem cell transplantation (ASCT) or intensified chemotherapy—or maintenance therapy experience superior outcomes.
Maintenance approaches in our cohort mainly included BTK inhibitors, PD-1 antibodies, and immunomodulatory drugs (IMiDs). Patients receiving consolidation or maintenance demonstrated significantly better disease control compared with those treated with induction alone.
Currently, many centers favor BTK inhibitors in the maintenance setting. This is biologically justified, as PCNS-DLBCL frequently belongs to the MCD subtype, driven by MYD88 and CD79B mutations, resulting in constitutive B-cell receptor signaling. BTK inhibition therefore represents a rational therapeutic strategy in both induction and maintenance.
Our center is actively conducting clinical studies evaluating BTK inhibitor–based combinations in MCD-type lymphomas, and further results will be shared in due course.
Abstract Summary
Abstract 5475
Title: Efficacy and safety of rituximab plus high-dose methotrexate and thiotepa (R-MT) as first-line induction therapy for PCNS-DLBCL
- 36 newly diagnosed PCNS-DLBCL patients
- ORR 97.2%, CRR 80.6% after four induction cycles
- 2-year PFS 63.9%, OS 82.9% (median follow-up 19 months)
- Patients receiving ASCT consolidation or BTKi/IMiD maintenance achieved markedly superior PFS
- No grade 5 adverse events; hematologic toxicity manageable even in patients >60 years
Conclusion: R-MT offers excellent efficacy with acceptable toxicity as first-line induction therapy. Induction alone is associated with early progression, whereas ASCT consolidation or BTKi/IMiD maintenance significantly improves long-term outcomes.
Viral Infection and DLBCL
Prognostic Impact and Clinical Management Implications
A second 5-year retrospective study (Abstract No. 3668) from Prof. Bai’s team demonstrated that concurrent viral infection is an independent adverse prognostic factor in DLBCL NOS, with clear implications for risk stratification and treatment planning.
Prof. Ou Bai
The relationship between viral infection and lymphoma is complex and clinically important. EBV is directly implicated in classical Hodgkin lymphoma, NK/T-cell lymphoma, and AITL, while HIV significantly increases lymphoma incidence.
Our long-term focus has been on hepatitis B virus (HBV) and lymphoma. Across multiple studies, we have shown that HBV-associated DLBCL is characterized by advanced stage, aggressive biology, frequent extranodal involvement, and inferior survival. Even with standard R-CHOP therapy, both PFS and OS are significantly worse compared with HBV-negative patients.
These findings highlight the necessity of routine viral screening (HBV, HCV, EBV, HIV) and dynamic viral monitoring during lymphoma treatment. For HBV-positive patients receiving anti-CD20 therapy, prophylactic antiviral treatment is mandatory to prevent reactivation.
In EBV-related settings, clinicians must carefully differentiate viral reactivation from disease progression, particularly when patients present with recurrent lymphadenopathy or fever, as this distinction directly influences therapeutic decisions and prognosis.
We have also explored chidamide plus CHOP induction followed by chidamide maintenance in HBV-positive DLBCL, with preliminary results already published. Ongoing studies will further refine treatment strategies for virus-associated lymphomas.
Abstract Summary
Abstract 3668
Title: Concurrent viral infection as an adverse prognostic factor in DLBCL NOS
- 727 newly diagnosed DLBCL NOS patients
- 22.1% had concurrent viral infection (HBV, EBV, HCV, HIV, CMV)
- Virus-positive patients had:
- Higher rates of advanced stage (III–IV)
- Elevated LDH and β2-microglobulin
- Viral infection independently predicted:
- Inferior PFS (HR 1.82)
- Inferior OS (HR 2.13)
Conclusion: Concurrent viral infection defines a high-risk DLBCL population with heavier tumor burden and significantly poorer outcomes, warranting intensified monitoring and novel therapeutic strategies.
Expert Profile
Prof. Ou Bai The First Hospital of Jilin University
- Deputy Director, Department of Hematology
- Head, Lymphoma Specialty Alliance
- National expert in lymphoma subspecialty capacity building
- 110 publications; 42 SCI papers as first/corresponding author
- Principal investigator of 30 national and provincial research projects
