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How I manage patients with relapsed/refractory diffuse large B cell lymphoma.

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Gisselbrecht, Christian Van Den Neste, Eric [UCL]

Despite progress in the upfront treatment of diffuse large B cell lymphoma (DLBCL), patients still experience relapses. Salvage chemotherapy followed by autologous stem cell transplantation (ASCT) is the standard second-line treatment for relapsed and refractory (R/R) DLBCL. However, half of the patients will not be eligible for transplantation due to ineffective salvage treatment, and the other half will relapse after ASCT. In randomized studies, no salvage chemotherapy regimen is superior to another. The outcomes are affected by the secondary International Prognostic Index at relapse and various biological factors. The strategy is less clear in patients who require third-line treatment. A multicohort retrospective non-Hodgkin lymphoma research (SCHOLAR-1) study conducted in 636 patients with refractory DLBCL showed an objective response rate of 26% (complete response 7%) to the next line of therapy with a median overall survival of 6·3 months. In the case of a response followed by transplantation, long-term survival can be achieved in DLBCL patients. There is clearly a need for new drugs that improve salvage efficacy. Encouraging results have been reported with chimeric antigen receptor -T cell engineering, warranting further studies in a well-defined control group of refractory patients. The Collaborative Trial in Relapsed Aggressive Lymphoma (CORAL) was used as a handy framework to build the discussion.

Document type Article de périodique (Journal article) – Synthèse de littérature
Access type Accès libre
Publication date 2018
Language Anglais
Journal information "British Journal of Haematology" - Vol. 182, no.5, p. 633-643 (2018)
Peer reviewed yes
Publisher Wiley-Blackwell Publishing Ltd. ((United Kingdom) Oxford )
issn 0007-1048
e-issn 1365-2141
Publication status Publié
Affiliations UCL - SSS/DDUV - Institut de Duve
UCL - SSS/DDUV/BCHM - Biochimie-Recherche métabolique
UCL - (SLuc) Service d'hématologie
MESH Subject Antineoplastic Combined Chemotherapy Protocols ; Cell- and Tissue-Based Therapy ; Disease Management ; Hematopoietic Stem Cell Transplantation ; Humans ; Immunotherapy, Adoptive ; Lymphoma, Large B-Cell, Diffuse ; Salvage Therapy
Keywords CAR-T cells ; HSC transplantation ; Cellular therapies ; Chemotherapy ; Refractory/relapsed DLBCL
Links
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Bibliographic reference Gisselbrecht, Christian ; Van Den Neste, Eric. How I manage patients with relapsed/refractory diffuse large B cell lymphoma.. In: British Journal of Haematology, Vol. 182, no.5, p. 633-643 (2018)
Permanent URL http://hdl.handle.net/2078.1/219050