Advances in Lymphoma
Transcript: Is R-CHOP suitable for late-relapse DLBCL?
Dr Francine Foss
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So this was a very interesting study, which is again a retrospective analysis of the use of R-CHOP in patients who have late relapse with DLBCL, and late relapse is defined as seven years median From the time of initial diagnosis to relapse. In this group of patients, they reported a 60% overall response rate and a time to progression at two years of 55%. So those numbers were very respectable and in keeping with what we would hope to achieve in this patient population. So I think this study is interesting because it demonstrates, again, the efficacy of going back to R-CHOP. But in the modern era, in the era where we now have CAR-T, and we have other targeted agents and a plethora of novel therapies in B-cell lymphoma, I think that the positioning of this with respect to those other therapies is unclear.
In particular for patients who are older that might have comorbidities, I think that there might be some other options available with bispecific antibodies, for instance, or some of the novel targeted agents. I think that's a very interesting question and it points to the fact that we should always try to get a biopsy in these patients and we should really try to look at the original pathology as well to determine whether or not this is a second B-cell lymphoma, so to speak, or whether it's the original tumour. There's also an argument about whether you define this as potentially like relapse disease so far out, and I think what this study actually demonstrates is that these patients can be treated de novo with basic kind of frontline therapy. In the modern age though with Polatuzumab R-CHP regimen, I think one could consider using one of these novel approaches instead of just going back to R-CHOP, and I think that would depend on the individual patient as well as the subtype.