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Treatment Overview for Diffuse Large B-Cell Lymphoma

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Published on September 16, 2021

New FDA Approvals and CAR T-Cell Therapy for DLBCL

What does the treatment journey for diffuse large B-cell lymphoma (DLBCL) entail? What are the most common side effects? Finally, what do we know about newly approved treatment options such as CAR T-cell therapy? Follow along as Dr. Brian Hill, MD, PhD, of the Cleveland Clinic Taussig Cancer Institute, gives an overview of treatments for DLBCL.


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Transcript | Treatment Overview for Diffuse Large B-Cell Lymphoma

Dr. Hill:
Yeah. So, for diffuse large B-cell lymphoma, which is the most common lymphoma, we have pretty good outcomes with traditional chemotherapy; most commonly R-CHOP, which many patients receive as their first treatment. Or something a little more souped-up than that called EPOCH with Rituxan (rituximab), so we call it R-EPOCH. Similar drugs as R-CHOP, but given over five days instead of one, in a little more higher doses.

If that works, then you may be cured and you may be done, and it usually does. But, for the cases and patients in which the DLBCL doesn't go away completely with R-CHOP or similar treatments, historically we've relied on stem cell transplant. So called autologous stem cell transplant after high doses of chemotherapy. But now we have CAR T-cell treatment, which maybe you're familiar with. This stands for chimeric antigen receptor T cells, which are your own T cells collected and modified outside of the body in a laboratory through a process which takes about three weeks, and then they're given back. It has to be given at an authorized treatment center where everyone has experience collecting and giving back these cells and managing some of the side effects.

So, the side effects can be pretty significant in terms of fevers, racing heart, low blood pressure – things that sometimes require intensive care unit monitoring. So, it's not a simple thing that can just be done at a place that doesn't do this regularly. And similarly, with high-dose chemotherapy with transplant, it again has to be done at a bone marrow transplant referral center, and these are usually the similar institutions.

What Are the New Treatment Options for DLBCL?


There are new drugs, however, other than just the cell therapy. There's three I'll just mention in passing in the interest of time. There's, in the order they were approved, there's a medication called polatuzumab vedotin (Polivy), there's one called tafasitamab (Monjuvi), and a couple others. There's loncastuximab (Zynlonta) most recently, and there's an oral medication selinexor (Xpovio). So, those are all FDA-approved for patients with DLBCL after prior lines of therapy. It's not clear which one of these is the best and some of them, there's some unique side effects about each one. What I would say is, if you have the diffuse large B-cell lymphoma, and it didn't go away and stay away or stay in complete remission after the first treatment, then it's really worth consulting with a specialist. Either in person or virtually at your referral center nearest you, because those are typically the centers that have a little more experience using some of these newer agents, as well as cell therapy and transplant.

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