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ICML 2021 | Developments in B-cell lymphoma management

Franco Cavalli, MD, FRCP, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland highlights advances in B-cell lymphoma treatment. Results from the Phase III FOLL12 trial (NCT02063685) demonstrated the superior efficacy of standard rituximab maintenance. The importance of specializing treatment based on genetic subgroups in patients with diffuse large B-cell lymphoma in a Phase II trial (NCT04025593) was also discussed, where R-CHOP-X (R-CHOP plus different treatments such as lenalidomide or ibrutinib) improved outcomes. R-CHOP-21 has additionally proven to be inferior to R-CHOP-14 and dose-adjusted R-EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) in patients with primary mediastinal lymphoma. This interview took place during the 2021 International Conference on Malignant Lymphoma (16-ICML).

Transcript (edited for clarity)

Of course in the Western countries, more than 85% of the lymphomas are of B-cell origin. There were very many exciting abstracts concerning B-cell lymphomas. In the plenary session, we had a study presented by the French group Eliza and in that study for the first time, it was shown to give us a possibility to individualize the treatment. This is already a standard approach in Hodgkin lymphoma, but it was not yet seen in non-Hodgkin lymphomas...

Of course in the Western countries, more than 85% of the lymphomas are of B-cell origin. There were very many exciting abstracts concerning B-cell lymphomas. In the plenary session, we had a study presented by the French group Eliza and in that study for the first time, it was shown to give us a possibility to individualize the treatment. This is already a standard approach in Hodgkin lymphoma, but it was not yet seen in non-Hodgkin lymphomas. And they showed in almost 800 cases of localized diffuse large B-cell lymphomas, that’s by basing your choice on an interim PET you can reduce without losing anything in the cure rate, the R-CHOP from six courses to four courses.

The Italian group, which has been always very active in studies, including follicular lymphomas, has presented a preliminary analysis of a response adapted post-induction treatment in follicular lymphomas. Again, about 750 patients induction regimen R-CHOP or BR and basing the treatment choice on interim PET and on minimal residual disease. They were comparing after induction, just observation or one year of maintenance, or even in the PET positive by adding immunoconjugate antibodies. And they were showing for the first time that by doing so, you can improve the outcome also after a few years of follow-up. Again, a very important study.

And I would assume it’s the first real trial in that sense, the study was presented by the Shanghai group led by Professor Weili Zhao since the different genetic subgroups of diffuse large B-cell lymphomas are becoming more and more important and used worldwide. They compared the classical R-CHOP to R-CHOP plus X whereby the X was different in different genetic subgroups of diffuse large B-cell lymphoma. Either it was, ibrutinib or lenalidomide or an HDAC inhibitor or B53 inhibitor.

And they were able to show that by differentiating in a randomized way, but adapting to the genetic sub-goal as a treatment, the outcome was better. This is the first time we’re showing that because in the past, comparing in all patients with diffuse large B-cell lymphomas, R-CHOP versus R-CHOP plus something, all the studies have been so far negative disease. The first study which is positive, but differentiating among four different subgroups and whereby the added agent was different into four different subgroups. And I would conclude this review by briefly presenting the huge ILSG studies with primary mediastinal lymphoma, including more than 500 patients.

The main question here is whether after induction, we need radiotherapy or not in patients who have become PET negative. This answer is not yet here because a longer follow-up will be needed, but we have already the answer concerning induction. And for the first time, it was shown that R-CHOP-21 should be forgotten in the treatment of primary mediastinal large B-cell lymphomas since R-CHOP-21 is clearly inferior to R-CHOP-14 or dose-adapted R-EPOCH in the treatment of primary mediastinal lymphoma. So this among the very many apps I presented, this was four important, most probably practice-changing results, which were presented at 16-ICML.

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