How would you consolidate a patient with primary refractory double hit lymphoma with secondary CNS involvement?

At the time of initial diagnosis, there was no clear CNS involvement. When it became clinically apparent disease was refractory to EPOCH, there was CSF involvement. Now clinically responding to R-DHAOx. Would you extrapolate from studies like ZUMA-7 and TRANSFORM and go to CART, or consider thiotepa-based auto if CR is achieved? Limited co-morbidities and excellent performance status.

2 Answers

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Hematology · Keck School of Medicine of USC

Answered on · Updated on

Thiotepa-based transplants are particularly rough. We haven't had good outcomes with them in terms of relapse and mortality is much higher than BEAM or Mel autos.

Having said that, this patient has chemo-refractory disease. The initial concern with CAR-T in primary CNS or secondary involvement was the potential increased risk for ICANs but there is some retrospective data that shows no increased risk and there are ongoing trials that will answer this question.

I agree with opting for CAR-T as second line if you are able to control the CNS involvement.

Ayuk et al., PMID 37450376

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Medical Oncology · University of Maryland Cancer Center

Answered on · Updated on

I would extrapolate from the 2L CAR-T trials and will offer CAR-T therapy assuming that his CNS disease is relatively under control.

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How would you consolidate a patient with primary refractory double hit lymphoma with secondary CNS involvement?

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