How would you treat an elderly newly diagnosed tDLBCL that has previously seen R-CHOP and Bendamustine-Obinutuzumab prior to the transformative event?
I would give tafasatimab and Revlimid per the L-MIND study. I have been so impressed by this well tolerated immunotherapy regimen and the durability of responses. Literally, it looks competitive with car T cell therapy. Car, T cells would be an option, if the patient is very fit for their age and th...
If the goal is palliation then Tafasitamab + lenalidomide or bi-specifics. If the goal is cure and the patient is reasonably fit, then CAR T.
It's a tough question, as there's no single standard of care approach here, especially because the patient-specific details really matter here. Options basically boil down to whether the patient is felt to benefit more from a cytotoxic approach or from a T-cell engaging approach. Approaches could be...
Interesting case. In a similar case, I gave R-GCVP and achieved long remission. However, it depends on the time interval between prior regimens. If it was short, I’d probably do something like Len-Rituximab or Len-Tafa and justify the patient is transplant-ineligible.
I would test his candidacy for CD19 CAR-T with Liso-Cel and if eligible, I would offer it to him. The PILOT study (Sehgal et al., PMID 35839786) showed that the transplant-ineligible population (including those age 70 and above) achieved an ORR of 80% (54% CR) and those achieving CR have a long dura...
Taftasimab and lenalidomide: well tolerated in elderly patients, good remission.
It really depends on the patient's functional status. If healthy/fit, I would treat with CAR-T. If borderline health/fitness, I would treat with tafasitamab and Revlimid.
I would defer ASCT eligibility to the transplant physician. Personally, this patient's disease appears chemo-refractory.
He is an ideal candidate for liso-cel (or axi-cel, depending on the closest center performing CAR-T), provided he checks all the required boxes for eligibility for CAR-T.
I'd be c...
I think it might depend on how long ago the prior chemotherapies were. If relatively remote, some kind of "salvage" (Pola-BR?) then auto transplant would be reasonable. I know this is transformation but if the chemo was relatively recent, I probably would try to get that person to CAR-T ASAP if an o...