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Pola-R-CHP-X is an investigational, genotype-guided combination regimen being evaluated in the Phase 3 GUIDANCE 05 trial for the treatment of previously untreated double-expression diffuse large B-cell lymphoma (DLBCL). The regimen builds upon the Pola-R-CHP backbone (polatuzumab vedotin, rituximab, cyclophosphamide, doxorubicin, and prednisone) by adding a personalized targeted agent ('X') based on the patient's genetic subtype. The 'X' component is selected following initial treatment and ctDNA monitoring: acalabrutinib (a BTK inhibitor) for MCD/BN2/N1-like subtypes, lenalidomide (an immunomodulatory agent) for EZB or ST2-like subtypes, decitabine (a hypomethylating agent) for TP53-mutated subtypes, or a PD-1 inhibitor for C1 subtypes. This precision medicine approach aims to improve outcomes in high-risk DEL patients by tailoring therapy to the underlying molecular drivers of the disease.
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