John P. Leonard, MD: I want to thank all of you. It's been a really great and informative discussion. We've covered the waterfront of relapsed and refractory large cell lymphoma. Before we finish up, I want to give you each a chance to give us a quick take home message for practitioners taking care of patients with large cell lymphoma, and I'll start with Nathan, then Matt, and then Kami. Nathan?
Nathan H. Fowler, MD: In the past 5 years, we've seen a huge change in the outcome of patients who are failing auto transplant. To me, that's the biggest take home message of what’s happened in the last several years; patients who fail transplant—in the past, I was trying to do everything I could to find something just to prolong outcomes— now have curative regimens that are curing a significant portion of them and there are even better versions of those coming out in the next couple of years.
It's a great time to refer patients to clinical trials because some of the cellular therapies look very active and so it's a wonderful time for patients. Not that it's ever good time to have relapsed large cell lymphoma, but the outcomes and the available options are like nothing we've seen in generations.
John P. Leonard, MD: Matt?
Matthew Lunning, DO: I don't want the perception to be that cellular therapy for is all, rather a discussion on cellular therapy for all is reasonable. Many patients may not go on to get cellular therapy and, as we pointed out in this discussion, there are a lot of new compounds being studied and some that will make it into the commercial use. But at the end, thinking about large cell lymphoma even from a diagnosis, it’s important to determine what your strategy is going to be and you hope that you're in that bucket of 75% that may be long-term survivors. You know that you have to prepare for the quarter that are not. That's where the game really gets tough and you need a strategy. You need a team to have the strategy in relapsed/refractory large cell lymphoma and a lot of times, it helps to have a cellular therapy institution in your corner.
John P. Leonard, MD: Kami?
Kami Maddocks, MD: I agree with Nathan that it's an exciting time in relapsed/refractory large cell lymphoma with the approval of agents such as CAR T [chimeric antigen receptor T-cell] therapies, polatuzumab, the excitement of potentially tafasitamab and lenalidomide. These are providing options to patients who previously didn't have options. We are curing more patients with CAR T therapy and hopefully we just get better as far as outcomes from those therapies as we improve the constructs and decrease toxicity.
I think that, moving forward, places that we can continue to do better are increasing the rate of cure in those patients with high risk disease from the beginning. In patients who are not candidates or who progress after both auto [autologous stem cell transplant] and CAR T, we can work towards having more effective options, possibly in some of the immunotherapies like bispecifics.
John P. Leonard, MD: I think large cell lymphoma is getting more complicated despite our profiling data has not translated into improved outcomes. People are used to kind of giving everybody R-CHOP [rituximab, cyclophosphamide, doxorubicin hydrochloride (hydroxy daunomycin), vincristine sulfate (Oncovin) prednisone] upfront and crossing their fingers but I think the relapse setting is becoming more and more complex. Probably, before long, we’ll need more sophistication in how we approach these patients. Hopefully, that means we're using them more effectively and have more tools at our disposable.
Thank you all again. I want to thank our audience for joining us today as well. We hope you found this OncLive® Peer Exchange discussion to be useful and informative. Thank you.
Transcript Edited for Clarity