In treating diffuse large B-cell lymphoma (DLBCL), oncologists have traditionally relied on the chemotherapy backbone of R-CHOP as standard of care. The two dangers that the hematologist must navigate between are the aggressive disease (Charybdis that in the absence of therapy systematically destroys all the ships) and the toxicity of the therapies (Scylla with its six monstrous heads that devours six crew members at a time), and hematologists have to navigate very carefully between both. Therefore, three different strategies were employed with the goal of improving cure rates: de-escalating regimens, escalating regimens, and replacement strategies. With a replacement strategy, a breakthrough in treatment was identified with polatuzumab vedotin (anti-CD79B antibody/drug conjugate) plus R-CHP. However, this regimen still did not achieve the elusive universal cure rate. Fortunately, advances in genomic and molecular technologies have allowed for an improved understanding of the heterogenous molecular nature of the disease to help develop and guide more targeted, precise, and individualized therapies. Additionally, new pharmaceutical technologies have led to the development of novel cellular therapies, such as chimeric antigen receptor (CAR) T-cell therapy, that could be more effective, while maintaining an acceptable safety profile. Thus, we aim to highlight the challenges of DLBCL therapy as well as the need to address therapeutic regimens eventually no longer tethered to a chemotherapy backbone. In the intersection of artificial intelligence and multi-omics (genomics, epigenomics, transcriptomics, proteomics, metabolomics), we propose the need to analyze multidimensional biologic datato launch a decisive attack against DLBCL in a targeted and individualized fashion.

中文翻译：

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在 Scylla 和 Charybdis 之间导航：在 DLBCL 中比 Pola-RCHP 做得更好的路线图

在治疗弥漫性大 B 细胞淋巴瘤 (DLBCL) 时，肿瘤学家传统上依赖 R-CHOP 的化疗骨干作为护理标准。血液学家必须应对的两种危险是侵袭性疾病（卡律布狄斯在没有治疗的情况下会系统性地摧毁所有船只）和治疗的毒性（锡拉有六个巨大的头，一次吞噬六名船员），血液学家必须非常小心地在两者之间进行选择。因此，为了提高治愈率，采用了三种不同的策略：降级方案、升级方案和替代策略。通过替代策略，polatuzumab vedotin（抗 CD79B 抗体/药物偶联物）加 R-CHP 实现了治疗突破。然而，这个方案仍然没有达到难以捉摸的普遍治愈率。幸运的是，基因组和分子技术的进步使我们能够更好地了解疾病的异质分子性质，从而帮助开发和指导更有针对性、更精确和个体化的治疗方法。此外，新的制药技术促进了新型细胞疗法的发展，例如嵌合抗原受体 (CAR) T 细胞疗法，这种疗法可能更有效，同时保持可接受的安全性。因此，我们的目的是强调 DLBCL 治疗的挑战以及解决治疗方案最终不再受化疗支柱束缚的需要。在人工智能与多组学（基因组学、表观基因组学、转录组学、蛋白质组学、代谢组学）的交叉领域，我们提出需要分析多维生物数据，以有针对性、个体化的方式对DLBCL发起决定性攻击。