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EHA 2025 | Treatment sequencing in elderly patients with DLBCL in the current era
In this video, Swetha Thiruvengadam, MD, City of Hope, Duarte, CA, discusses her approach to treatment sequencing in elderly patients with diffuse large B-cell lymphoma (DLBCL), highlighting the importance of considering effective and safe treatments for this patient population. This interview took place at the 30th Congress of the European Hematology Association (EHA) in Milan, Italy.
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Transcript
I think it’s an exciting time in the field that we have such great options for our DLBCL patients, and including our elderly patients, as we know the majority of DLBCL is diagnosed in older patients, so I think it’s very important to consider treatments that work effectively and are safe in this patient population.
So I think, we now have CAR T-cell therapy, as well as bispecific antibodies that are FDA approved for relapsed/refractory DLBCL...
I think it’s an exciting time in the field that we have such great options for our DLBCL patients, and including our elderly patients, as we know the majority of DLBCL is diagnosed in older patients, so I think it’s very important to consider treatments that work effectively and are safe in this patient population.
So I think, we now have CAR T-cell therapy, as well as bispecific antibodies that are FDA approved for relapsed/refractory DLBCL. And in the second-line setting, based on the pilot data, liso-cel is often used for patients who would otherwise be transplant ineligible, even with late relapse for CAR-T after frontline chemoimmunotherapy. So I think for my elderly patients, I tend to, if I’m going with CAR-T, I tend to choose liso-cel because it has less toxicity, but still comparable efficacy. And I definitely, if they’re older and more frail, I definitely avoid, in general, stem cell transplant, given the higher toxicities for that.
Now with bispecifics, I think that gives another great option for elderly patients. So I think if they’re, you know, second-line relapsed patients, and elderly and more frail, I either think about liso-cel versus the bispecific agent glofitamab for our patients, depending on whether they have access to coming to an academic center or depending on kind of what their wishes are, whether they would like a one-time treatment versus a more continuous treatment and kind of discussing both. Of course, bispecifics are not FDA approved yet in the second-line setting, so they would have to get it on a clinical trial.
So I think if you’re thinking about an FDA-approved commercial setting, I’d probably give them frontline chemotherapy, and then second-line liso-cel CAR-T, and then third-line bispecific for our elderly patients. So I think we do have a lot of great choices at this time, and I think sequencing becomes an important question as we get more data with bispecifics in the second-line setting. I think it’ll be yet to be determined which one to sequence before the other.
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Disclosures
Research funding: GNE, Genmab/Abbvie, ADC-T, Ipsen; Advisory Board/Consulting: Kite, Ipsen, Abbvie.
