The Fellow on Call: The Heme/Onc Podcast Episode 077: Management of relapsed diffuse large B-cell lymphoma (DLBCL) - part 1
Oct 18, 2023
The discussion centers on managing relapsed diffuse large B-cell lymphoma (DLBCL) and dives into complex treatment strategies. The hosts share insights on dealing with CNS involvement, comparing CAR-T therapy with autologous transplant options. Tailoring treatment for individual patients is emphasized, especially in elderly cases where traditional therapies might not be viable. The episode underscores the significance of innovative approaches like polituzumab-vidotin to improve outcomes, providing a rich blend of expertise and relatable anecdotes.
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Relapse DLBCL Treatment Approach
- For relapsed DLBCL, assess if the patient is fit for high-dose chemotherapy plus autologous stem cell rescue or CAR-T therapy.
- Use platinum-based salvage chemotherapy first in patients with relapse beyond 12 months before deciding next steps.
Manage CNS Involvement in DLBCL
- For CNS involvement in DLBCL relapse, use IV high-dose methotrexate for parenchymal brain disease and intrathecal triple therapy for leptomeningeal spread.
- Deliver intrathecal methotrexate, cytarabine, and hydrocortisone twice weekly until CSF cleared, then taper the frequency.
Response-Based Treatment Decisions
- Achieving a complete response to platinum salvage chemotherapy usually leads to autologous stem cell transplant.
- If partial response or stable disease, favor CAR-T therapy due to possible chemoresistance.