Insights From:Jennifer R. Brown, MD, PhD, Harvard Medical School; Richard R. Furman, MD, Weill Cornell Medical College; Brad S. Kahl, MD, UW Carbone Cancer Cente
Treatment in patients with relapsed diffuse large B-cell lymphoma (DLBCL) following R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) therapy is an area of uncertainty, states Richard R. Furman, MD.
Due to its curative potential, stem cell transplantation should be offered to patients with relapsed DLBCL who are eligible, comments Brad S. Kahl, MD. In this approach, R-ICE (rituximab plus ifosfamide, carboplatin, and etoposide) or R-DHAP (rituximab, dexamethasone, high-dose cytarabine, and cisplatin) chemotherapy is typically administered. If patients experience at least a partial remission, they are advanced to autologous stem cell transplantation, which may cure about half of the patients, notes Kahl.
Data supporting the use of autologous stem cell transplantation in individuals with chemotherapy-sensitive relapses were generated before the R-CHOP chemotherapy regimen, says Furman. More recent studies are exploring the benefit of this procedure after relapse on R-CHOP. Autologous stem cell transplantation should be offered to patients who are sensitive to salvage chemotherapy, adds Furman.
Patients who achieve less than partial response to salvage chemotherapy may need to be treated with non-chemotherapeutic approaches because their response to stem cell transplantation may be less than optimal and associated with more toxicities. Experimental approaches, such as ibrutinib and idelalisib, may be appropriate in this setting, says Furman. Ibrutinib has demonstrated activity in recurrent DLBCL, particularly in patients with the ABC subtype, adds Kahl.