Updates in the Management of Diffuse Large B-Cell Lymphoma

Yazan Samhouri, MD, a hematologist/oncologist in the Division of Hematology and Cellular Therapy at Allegheny Health Network (AHN), discusses the latest advancements in the diffuse large B-cell lymphoma treatment landscape, including improving upon rituximab (Rituxan) plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), the promise of bispecific antibodies, and more.

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0:08 | There [have been] a lot of exciting changes in the last few years in diffuse large B-cell lymphoma. Usually in first-line settings, we still use chemoimmunotherapy as a standard of care, but we are always trying to improve that. R-CHOP is also usually a standard of care, but we’re [also] trying to improve that by adding novel therapies to it like bispecific T-cell engagers or monoclonal antibodies.

0:38 | There’s a clinical trial ongoing at AHN of lenalidomide in addition to R-CHOP compared with R-CHOP in the first-line. This treatment usually cures around 60% of the patients, but still there are 40% of patients that relapse or need further treatment. In the second-line setting, it depends when the patient relapses. If it's a late relapse, we usually go for salvage chemotherapy followed by an autologous stem cell transplantation. If it’s an earlier relapse, we think of chimeric antigen receptor [CAR] T-cell therapy based on the ZUMA-7 [NCT03391466] trial from last year.

1:22 | Bispecific T-cell engagers are promising, and we were all excited in the field about them and hearing about all the data for glofitamab and other bispecific T-cell engagers like epcoritamab [DuoBody®-CD3xCD20]. Those are exciting drugs because of the mechanism of action. They bind to CD3 on the T cells and bind to another target which is usually a CD20 on the lymphoma cells, and then they bring the T cells to the lymphoma cells to kill it and activate the immune system. They are a useful tool because they can be given in the community in contrast to CAR T-cell therapy which needs to be in a transplant or a CAR T center. This can expand access to a very useful treatment for our patients in this field.

2:12 | Also, the toxicity of these agents also seems similar to CAR T-cell therapy in terms of the cytokine release syndrome and neurotoxicity, but the rate of these toxicities are lower, and the grades are also lower.