Reviewing Current Therapies in Relapsed DLBCL and the L-MIND Trial

Christopher R. Flowers, MD, department chair of the Department of Lymphoma/Myeloma, Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center, discusses the current therapies used for patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) and goes into specifics of the L-MIND trial (NCT02399085) after the long-term follow-up.

There are multiple therapies and therapy combinations approved in this setting, including chimeric antigen receptor (CAR) T-cell therapy. The 2021 American Society of Clinical Oncology (ASCO) Annual Meeting provided some updated for trials in this space, including the multicenter, open-label, single-arm, phase 2 study L-MIND trial.

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0:08 | What we have, however, seen is a dramatic change in the numbers of therapies that are available in the relapse setting. That's with the advent of polatuzumab [Polivy] combined with bendamustine and rituximab [Rituxan], tafasitamab [Monjuvi] combined with lenalidomide [Revlimid], and now loncastuximab tesirine [Zynlonta] approved in that third or later line space of therapy, and the advent of 3 different CAR T-cell therapies that are now approved in the relapse setting for DLBCL. Then selinexor [Xpovio] that's also approved in that space. So really a whole host of options. At this year's ASCO meeting, we saw an update on some of those trials, and particularly the one looking at the combination of tafasitamab and lenalidomide, or the L-MIND trial.

What were the design and efficacy of the L-MIND trial?

1:08 | When we look at the L-MIND trial, it's a trial that was published with updated results in Lancet Oncology in 2020 describing a patient population of about 81 patients. When you look at the characteristics of the population, the median age at the time of enrollment was about 72 years, which is relatively similar to what we would see for a general population of patients with DLBCL; 11% of those patients had a prior stem cell transplantation. This is generally an older patient population who did not have transplant as part of their course of care. The majority of patients had a median of 2 prior lines of therapy, so still relatively early in their treatment cycle. When you look at response rates, and particularly when you look at response rates by numbers or prior lines of therapy, what was presented in the updated results at ASCO showed for those patients who had 1 prior line of therapy, that the complete response rate was 48% versus those who had 2 or more prior lines of therapy, and the trial was divided about half and half between those 2 different groups. Those who had 2 or more prior lines of therapy had a complete response rate of 33%. The duration of response appeared to be quite durable for both groups being more than 44 months in both groups of responders.