The Fellow on Call: The Heme/Onc Podcast Episode 076: Management of primary refractory diffuse large B-cell lymphoma (DLBCL)
Oct 4, 2023
Explore the challenging landscape of primary refractory diffuse large B-cell lymphoma (DLBCL) management. Learn about the critical distinctions between primary refractory and relapsed disease. CAR-T therapy takes center stage, showcasing its role and the need for effective bridging strategies. A detailed case study of a patient reveals the complexities of treatment regimens. Finally, discover the importance of careful post-infusion monitoring and the advancements in managing refractory cases.
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Case Illustration of Primary Refractory DLBCL
- A 43-year-old male with high-grade B-cell lymphoma showed primary refractory disease after chemo.
- Despite partial response mid-therapy, PET scan revealed new disease sites prompting biopsy confirmation.
Assess Patient Fitness for Treatment
- Assess patient fitness carefully before intensive treatments like CAR-T or autologous transplant.
- Focus on organ function and physical capability rather than chronological age.
Classify Relapse Timing
- Categorize patients by relapse timing: primary refractory or relapse within 12 months versus after 12 months.
- This classification guides prognosis and subsequent treatment decisions.