Second Line Therapies for Diffuse Large B-Cell Lymphoma

According to a case-based roundtable meeting for Targeted Oncology, Matthew A. Lunning, DO, talked about second-line therapies for diffuse large B-cell lymphoma and the results of a study called L-MIND. There are a number of possible treatment regimens used as second line therapy in cases where transplant is not an option. Some examples as recommended by the National Comprehensive Cancer Network (NCCN) include:

  • Gemcitabine plus oxaliplatin, sometimes combined with rituximab
  • Polatuzumab vedotin-piiq, sometimes combined with bendamustine and/or rituximab
  • Tafasitamab-cxix plus lenalidomide

About Diffuse Large B-Cell Lymphoma

Diffuse large B-cell lymphoma (DLBCL), as the name suggests, is a cancer that affects B cells, which are a type of white blood cell. These cells are responsible for producing antibodies. There is a diverse array of different variants and subtypes of this cancer, and it is the most common form of non-Hodgkin’s lymphoma in adults. Although it can occur in children and young adults in the rarest cases, this type of lymphoma primarily affects older people, usually around 70 or older. Symptoms are typical of many lymphomas, and include night sweats, fatigue, unexpected weight loss, a noticeable mass in the lymph nodes, and fever. Risk factors include underlying immunodeficiencies and infection from the Epstein-Barr virus and Helicobacter pylori. Occasionally, this lymphoma can transform from other types of blood cancer. Treatment includes chemotherapy, rituximab, stem cell transplantation, and immunotherapy; the five year survival rate is 58 percent. To learn more about diffuse large B-cell lymphoma, click here.

Lunning also says that the NCCN recommends lab and physical exams every three to six months for five years following metabolic complete remission. Exams should continue on a yearly basis from then on. Imaging twice a year for two years is also recommended. For patients that have faced relapse twice or more, CAR T-cell therapy should be considered. However, the NCCN also notes that bendamustine can interfere with the success of this treatment approach.

In the L-MIND phase 2 study, patients with relapsed/refractory disease were treated with lenalidomide and tafasitamab. This study found that the rate of adverse effects with this treatment was relatively high (serious events occurred in around 50 percent of those treated), but it also showed better efficacy than treatment with lenalidomide alone.

Progress is ongoing in the development of second line approaches for diffuse large B-cell lymphoma.

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