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ASH 2024 | The evolving role of HSCT and optimal sequencing strategies for the treatment of R/R DLBCL
Megan Melody, MD, Cancer Center of South Florida, Palm Springs, FL, comments on the evolving role of hematopoietic stem cell transplantation (HSCT) in the management of relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) and the optimal sequencing of novel therapies. Dr Melody emphasizes the importance of considering individual patient factors, such as chemosensitivity and response to frontline therapy, when determining the most effective treatment approach. This interview took place at the 66th ASH Annual Meeting and Exposition, held in San Diego, CA.
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Transcript
Yeah, we’re at a really exciting time in malignant hematology, especially in the space of lymphoma. How fortunate are we that we have all these new developing therapies? But I think the problem is we want to give these patients a chance of cure. And so sequencing these therapies in order to optimize the patient’s chance of cure is paramount, essentially. And so what we know so far is that bispecific antibodies are an effective therapy for the treatment of lymphoma...
Yeah, we’re at a really exciting time in malignant hematology, especially in the space of lymphoma. How fortunate are we that we have all these new developing therapies? But I think the problem is we want to give these patients a chance of cure. And so sequencing these therapies in order to optimize the patient’s chance of cure is paramount, essentially. And so what we know so far is that bispecific antibodies are an effective therapy for the treatment of lymphoma. But currently response rates for relapsed/refractory disease are only about 35% and the duration of response is still so novel and new that we don’t have long-term follow-up data to really call these patients cured. What we do know is that in the second-line setting, patients who are not primary refractory, meaning that they relapse after 12 months of frontline chemotherapy, they have about a cure rate of 40% with autotransplant and that truly is an overall survival at five years. And so I still do feel that patients who demonstrate chemosensitivity, meaning that they’re able to achieve a response, complete response to frontline chemoimmunotherapy, and then maintain that response for over 12 months, that those patients should be still considered for an autotransplant. In terms of patients who have primary refractory disease or relapse within 12 months, those patients should be considered for CAR T-cell therapy, as shown by the ZUMA-7 and TRANSFORM clinical trials. And then those patients who are unable or unwilling to travel to a large community center or who are deemed ineligible for both CAR-T or autotransplant, in that situation we could be maybe considering bispecific antibodies in a second-line setting. But again, this is not how those drugs are approved. So I do still think there’s a role for autotransplant. I think, you know, it’s really exciting that we have all these novel therapies, but it’s important to keep the patient in mind and know that we really want to give them a cure for therapy.
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