Management of relapsed or refractory large B-cell lymphoma: A British Society for Haematology Guideline.

in British journal of haematology by Sridhar Chaganti, Christopher P Fox, Bernard D Maybury, Cathy Burton, Sally F Barrington, Timothy Illidge, Nagesh Kalakonda, Toby A Eyre, Pam McKay, Andrea Kuhnl, Kate Cwynarski, Andrew J Davies,

TLDR

  • Relapsed diffuse large B-cell lymphoma patients with early relapse have worse outcomes, while those with late relapse or second relapse benefit from specific treatment recommendations.

Abstract

Time to progression is the strongest predictor of outcome in relapsed diffuse large B-cell lymphoma. Second-line treatment with chimeric antigen receptor (CAR) T-cell therapy is recommended for patients with progression within 12 months of first-line chemoimmunotherapy. In patients with late relapse, platinum-based chemotherapy followed by high-dose chemotherapy with autologous stem cell rescue is recommended. In second relapse, CAR T-cell or CD3xCD20 bispecific antibody therapy is recommended in eligible patients. Other treatment options are available for less fit patients. Specific recommendations are made on diagnostic immunohistochemistry, bendamustine use and bridging to CAR T-cell therapy.

Overview

  • The study focuses on the analysis of relapsed diffuse large B-cell lymphoma (DLBCL) patients, examining the predictors of outcome and recommending treatment options.
  • The main hypothesis is that time to progression is a strong predictor of outcome in relapsed DLBCL patients.
  • The objective is to provide specific treatment recommendations for patients with relapsed DLBCL based on their timing and number of relapses.

Comparative Analysis & Findings

  • The study found that time to progression is the strongest predictor of outcome in relapsed DLBCL patients, with patients experiencing early relapse having worse outcomes.
  • Second-line treatment with chimeric antigen receptor (CAR) T-cell therapy is recommended for patients with progression within 12 months of first-line chemoimmunotherapy.
  • Patients with late relapse are recommended to undergo platinum-based chemotherapy followed by high-dose chemotherapy with autologous stem cell rescue, with CAR T-cell or CD3xCD20 bispecific antibody therapy recommended for those with second relapse and eligible patients.

Implications and Future Directions

  • These treatment recommendations have significant implications for the management of relapsed DLBCL patients, providing a framework for clinicians to follow.
  • Future studies could investigate the optimal timing and number of relapses for selecting treatment options, as well as explore new therapies for less fit patients.
  • Clinicians should be aware of the specific recommendations made in the study, including the use of diagnostic immunohistochemistry, bendamustine, and bridging to CAR T-cell therapy.
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