Resistance to covalent Bruton's tyrosine kinase inhibitors in diffuse large B-cell lymphoma: Molecular mechanisms and therapeutic implications (Review)
- 1Department of Hematology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China
- 2Northern Jiangsu Institute of Clinical Medicine, Nanjing Medical University, Huai'an, Jiangsu 223300, P.R. China
- 3Key Laboratory of Hematology of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
Abstract
B-cell receptor (BCR) signaling is essential for the survival and proliferation of normal B cells, and contributes substantially to the pathogenesis of diffuse large B-cell lymphoma (DLBCL). Bruton's tyrosine kinase (BTK), a key downstream component of the BCR pathway, has emerged as an important therapeutic target in B-cell malignancies. However, the clinical efficacy of BTK inhibitors (BTKi) in DLBCL remains heterogeneous and is strongly influenced by molecular subtype and signaling dependency. Accumulating evidence indicates that BTKi resistance in DLBCL is driven by diverse molecular mechanisms, including BTK mutations, gain-of-function alterations in phospholipase Cγ2, activation of the caspase recruitment domain family member 11-B-cell lymphoma/leukemia 10-mucosa-associated lymphoid tissue lymphoma translocation protein 1 complex and dysregulation of myeloid differentiation primary response 88, cluster of differentiation 79B, tumor necrosis factor-α-induced protein 3 and Kelch-like protein 14. In addition to these genetic determinants, non-genetic adaptive mechanisms, such as compensatory phosphoinositide 3-kinase/AKT/mechanistic target of rapamycin and mitogen-activated protein kinase/extracellular signalregulated kinase signaling, epigenetic reprogramming, tumor microenvironment remodeling, metabolic rewiring and endoplasmic reticulum stress, may further contribute to therapeutic escape. Emerging approaches, including next-generation covalent and non-covalent BTKi, dual-mode inhibitors, BTK-targeting degraders, allosteric inhibitors and multi-target strategies, are currently being investigated as potential strategies to address BTKi resistance. The present review summarized the molecular mechanisms underlying BTKi resistance in DLBCL and discussed their potential implications for biomarker development, rational combination therapy and future precision treatment.
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BibTeX
@article{lu2026resistance,
title = {{Resistance to covalent Bruton's tyrosine kinase inhibitors in diffuse large B-cell lymphoma: Molecular mechanisms and therapeutic implications (Review)}},
author = {Chuanyang Lu and Tingting Zhou and Wenxin Zhang and Lulu Wei and Qiuni Chen and Yuye Shi and Chunling Wang and Liang Yu},
journal = {International Journal of Oncology},
year = {2026},
month = oct,
doi = {10.3892/ijo.2026.5947},
url = {https://doi.org/10.3892/ijo.2026.5947},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Resistance to covalent Bruton's tyrosine kinase inhibitors in diffuse large B-cell lymphoma: Molecular mechanisms and therapeutic implications (Review)
AU - Chuanyang Lu
AU - Tingting Zhou
AU - Wenxin Zhang
AU - Lulu Wei
AU - Qiuni Chen
AU - Yuye Shi
AU - Chunling Wang
AU - Liang Yu
PY - 2026
DA - 2026/10/09
JO - International Journal of Oncology
DO - 10.3892/ijo.2026.5947
UR - https://doi.org/10.3892/ijo.2026.5947
AB - B-cell receptor (BCR) signaling is essential for the survival and proliferation of normal B cells, and contributes substantially to the pathogenesis of diffuse large B-cell lymphoma (DLBCL). Bruton's tyrosine kinase (BTK), a key downstream component of the BCR pathway, has emerged as an important therapeutic target in B-cell malignancies. However, the clinical efficacy of BTK inhibitors (BTKi) in DLBCL remains heterogeneous and is strongly influenced by molecular subtype and signaling dependency. Accumulating evidence indicates that BTKi resistance in DLBCL is driven by diverse molecular mechanisms, including BTK mutations, gain-of-function alterations in phospholipase Cγ2, activation of the caspase recruitment domain family member 11-B-cell lymphoma/leukemia 10-mucosa-associated lymphoid tissue lymphoma translocation protein 1 complex and dysregulation of myeloid differentiation primary response 88, cluster of differentiation 79B, tumor necrosis factor-α-induced protein 3 and Kelch-like protein 14. In addition to these genetic determinants, non-genetic adaptive mechanisms, such as compensatory phosphoinositide 3-kinase/AKT/mechanistic target of rapamycin and mitogen-activated protein kinase/extracellular signalregulated kinase signaling, epigenetic reprogramming, tumor microenvironment remodeling, metabolic rewiring and endoplasmic reticulum stress, may further contribute to therapeutic escape. Emerging approaches, including next-generation covalent and non-covalent BTKi, dual-mode inhibitors, BTK-targeting degraders, allosteric inhibitors and multi-target strategies, are currently being investigated as potential strategies to address BTKi resistance. The present review summarized the molecular mechanisms underlying BTKi resistance in DLBCL and discussed their potential implications for biomarker development, rational combination therapy and future precision treatment.
SN - 1019-6439
SN - 1791-2423
ER -