In a nutshell
This article reviewed current treatment options for patients with relapsed (cancer recurrence) or refractory (does not respond to treatment) diffuse large B-cell lymphoma (DLBCL).
DLBCL is one of the most common types of non-Hodgkin’s lymphoma. Typical first-line (primary) treatment involves chemoimmunotherapy. R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) is the most commonly used regimen. This treatment is effective in 60 – 70% of patients. However, 30 – 40% of patients experience relapse or develop refractory disease. Treatment remains challenging for these patients.
Methods & findings
For patients under age 70 without additional medical conditions, autologous stem cell transplantation (ASCT) remains the standard of care. High-dose chemotherapy is given first, to get rid of any remaining cancer cells. The most commonly used regimen for this is BEAM (carmustine, etoposide, cytarabine, melphalan), with or without rituximab (Rituximab). Then, healthy stem cells are collected from the patient and reintroduced back into the patient’s bloodstream.
Only about 40% of patients with relapsed or refractory DLBCL undergo ASCT. The remaining 60% do not undergo ASCT due to not responding to chemotherapy. Allogeneic SCT is an alternative treatment option for these patients. This involves replacing the patient’s cancer cells with healthy stem cells that come from a donor.
For elderly patients who are not eligible for SCT, new treatment approaches may be recommended. CAR T-cell therapy involves removing T-cells (immune cells) from the blood. The T-cells are modified in the lab to make a special protein called CAR. This protein helps the T-cells attack cancer cells. These CAR T-cells are then reintroduced into the patient.
Targeted therapies such as ibrutinib (Imbruvica) and venetoclax (Venclexta) are another treatment option. This type of treatment specifically targets cancer cells, leading to cancer cell death.
The bottom line
This article reviewed treatment options for patients with relapsed or refractory DLBCL.
Published By :
Best practice & research. Clinical haematology
Sep 01, 2018
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