We dived deep into the complexities of diffuse large B-cell lymphoma (DLBCL), one of the most aggressive yet potentially curable lymphomas. Drs. Rahul & Rohit Gosain are joined by Dr. John Leonard, a leading lymphoma expert from NYU Langone Cancer Center, who shared his insights on the latest data and evolving treatment landscape for DLBCL.
We started by discussing the initial workup for DLBCL, including the role of PET-CT scans and the decreasing necessity for bone marrow biopsies. Dr. Leonard emphasized the importance of molecular profiling and the use of immunohistochemistry to determine the subtype of DLBCL, which can influence treatment decisions.
As we transitioned to treatment strategies, we explored the use of R-CHOP and the newer Pola-R-CHP regimen in Stage 1 and Stage 2 settings, highlighting the shift towards a PET-adapted approach. Dr. Leonard discussed the potential role of polatuzumab in limited-stage patients, based on findings from the POLARIX study.
The bulk of our conversation focused on Stage 3 and Stage 4 disease, particularly in relapsed or refractory cases. Dr. Leonard shares his current practice of using Pola-R-CHP as a first-line treatment for patients with good performance status, while also addressing the nuances of treatment for frail patients and those with compromised ejection fractions.
We delved into CAR-T therapy, discussing its benefits and challenges, especially regarding patient access and logistics. Dr. Leonard provided insights into the decision-making process between different CAR-T options, such as Axi-cel and Liso-cel, and the emerging role of bispecific antibodies in treatment sequencing.
Finally, we touched on the importance of monitoring for side effects, including immunosuppression, after CAR-T and bispecific therapies. Dr. Leonard emphasized the need for community physicians to be aware of these long-term effects and the potential requirement for immunoglobulin supplementation.
In summary, this episode offered a comprehensive overview of the current landscape in DLBCL treatment, highlighting the importance of personalized approaches and the exciting developments on the horizon.
