The 2022 Tandem Meetings | Lorlatinib for chemotherapy-refractory and alectinib-refractory patients with ALK+ LBCL

ALK+ large B-cell lymphoma (LBCL) is an aggressive lymphoma with dismal outcomes and with few treatment options. These tumors are chemotherapy and radiotherapy resistant, and they do not express B-cell markers, rendering them ineffective for treatment with commercially available CAR-T therapies. In this video, Baldeep Wirk, MD, Penn State Cancer Institute, Hershey, PA, discusses the potential of lorlatinib in treating chemotherapy-refractory and alectinib-refractory patients with ALK+ LBCL by describing a patient’s case study. Dr Wirk explains that this patient was first treated with alectinib, achieved a complete metabolic response and was lymphoma-free, before undergoing an allogeneic peripheral blood stem cell transplant (alloPBSCT). However, the patient soon relapsed and did not respond to alectinib treatment. However, when the patient started taking lorlatinib, they were able to achieve a rapid and durable complete response. Plasma cell-free DNA (cfDNA) genotyping identified a mutation conferring resistance to alectinib in this patient. This suggests lorlatinib as a promising option for patients harbouring ALK resistance mutations. This interview took place at the Transplantation & Cellular Therapy (TCT) Meetings of ASTCT™ and CIBMTR® 2022 in Salt Lake City, Utah.