“Relapsed” means the disease comes back after an improvement, while “refractory” means the lymphoma is not responding to treatment or the response is very short-lived.
The majority (Up to 50-60%) of patients with Diffuse Large B cell lymphoma (DLBCL) can be potentially cured with standard chemoimmunotherapy, R-CHOP. 1 Even amongst patients who progress during initial immunochemotherapy or soon after a brief complete remission (meaning the disappearance of all signs of cancer in response to treatment), a standard treatment approach involves high-dose chemotherapy followed by a stem cell transplant. In most cases, these transplants are autologous, meaning the patient receives their own stem cells that were collected before the procedure. About 30% to 40% will achieve disease control with salvage chemotherapy and autologous stem cell transplantation (ASCT). 1
For patients with relapsed or refractory DLBCL after many previous standard lines (R-ICE, R-DHAP, R-GDP) of treatment, the chemotherapy regimens or agents used include (but are not limited to) the following:
- rituximab, ifosfamide, carboplatin, and etoposide (R-ICE)
- rituximab, dexamethasone, cisplatin, and cytarabine (R-DHAP)
- rituximab, gemcitabine, dexamethasone (R-GDP)
- obinutuzumab-based therapy (Gazyva)
- bendamustine-based therapy
- lenalidomide-based (Revlimid)
- bruton tyrosine kinase inhibitor- based therapy
- polatuzumab vedotin (Polivy)
However, a proportion of patients with relapsed/refractory DLBCL are unable to receive intensive high-dose chemotherapy or undergo stem cell transplantation due to their age, comorbidities, or disease refractoriness to standard chemotherapy. Also, a subset of patients, the disease remains refractory to many lines of chemoimmunotherapy or relapses after stem cell transplant.
This highlights the need for more effective therapies in this difficult-to-treat population. In recent years, immunotherapy (send hyperlink to my previous article) such as antibody conjugates, bispecific T-cell engager (BiTE), and cellular therapies like CAR-T cell therapy (Chimeric Antigen Receptor T cell) have emerged as potential treatment options for patients with relapsed/refractory DLBCL with the promise of durable long term disease control. Some of them have even been evaluated in clinical trials as a second line therapy (i.e., first relapse after RCHOP to replace ASCT).
| Bispecific T cell Engager (BiTE) | Chimeric Antigen Receptor T cell |
| Glofitamab (Columvi) | Tisagenlecleucel (Tisa-Cel), (Kymriah) |
| Epcoritamab (Epkinly) | Axicabtagene Ciloleucel (Axi-Cel), (Yescarta) |
References:
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– Contributed by Dr Lee Chun Tsu
