What salvage chemotherapy, if any, would you recommend for a patient with primary refractory DLBCL who progressed after two cycles of R-CHOP?
Primary progressive DLBCL is certainly clinically challenging. After biopsy confirms the diagnosis, how best to proceed depends on many factors including burden of disease, tempo of disease, and patient characteristics. ZUMA-7 establishes axi-cel as superior to the standard approach of platinum-base...
Although we use RICE or other platinum-containing regimens (R-DHAP, R-GemOx), these are unlikely to work well if there is progression after 2 cycles of R-CHOP. Polatuzumab vedotin +/- BR is effective but may not always be covered by insurance for second line treatment. Caution should be exercised in...
For patients with primary refractory DLBCL, I generally repeat a biopsy (if feasible) to confirm the diagnosis. Salvage chemotherapy choice depends on the fitness of the patient and the goal of the treatment. In general, I recommend CD19 CAR-T therapy with liso-cel (for older and medically unfit pat...
For patients who are primary refractory to 2 cycles of R-CHOP, I would consider these patients to be chemotherapy insensitive and I would then strongly consider proceeding to CAR-T cell therapy. Based on the ZUMA-7 and TRANSFORM trials, both axicabtagene ciloleucel and lisocabtagene maraleucel are ...