Paolo F. Caimi, MD, on DLBCL: Outcomes After R-ICE Chemoimmunotherapy

2022 ASH Annual Meeting and Exposition


Paolo F. Caimi, MD, of the Taussig Cancer Institute, Cleveland Clinic, discusses new findings showing that patients with diffuse large B-cell lymphoma (DLBCL) who achieve a complete response after salvage therapy with rituximab, ifosfamide, carboplatin, and etoposide (R-ICE) can achieve long-term disease control, regardless of the time to relapse from initial therapy, particularly if they proceed to autologous stem cell transplant (ASCT). These results suggest that second-line chemotherapy followed by ASCT and/or CAR T-cell therapy for chemosensitive and chemorefractory patients may maximize patient outcomes, regardless of time to relapse (Abstract 156).


Disclaimer: This video transcript has not been proofread or edited and may contain errors.
We found that the proportion of patients that have early relapse or refractory disease after R-CHOP or dose adjusted EPOCH that actually achieve a complete remission after R-ICE is approximately 30% of patients. And that those patients can, when they achieve a complete remission, and then go on to an autologous transplant, have comparable progression-free survival and overall survival with respect to patients who are late relapsers who are generally considered to be more chemosensitive. The implication of these findings is primarily to show that among those who have early relapse, there's a small portion of patients, about a third of patients, who are still chemosensitive who could potentially, if they achieve a complete remission, proceed to an autologous transplant and have expected progression for survival that's about 50% at four years. The importance of this is that in a current scenario where CAR Ts are preferred for patients with early relapse, we are still, because of logistics, because of access, and because of the global access to CAR T-cells, there's still patients that cannot access CAR T-cells before receiving salvage chemotherapy, or cannot access to CAR T-cells at all. So we wanted to document what happens with a chemosensitive patient that has received R-ICE, achieves complete remission, and whether an autologous transplant can provide them long-term disease control, which we found. I think it is in line, in terms of results, of what we see on the recent ZUMA-7 and TRANSFORM trials showing the superiority of CAR Ts in terms of event for survival with respect to salvage chemotherapy for a population that is overall expected to be more chemo-resistant. However, it shows that those who happen to be chemosensitive among those that are early relapsers can have long-term disease control. Future studies will include further refinement of the assessments of the outcomes of patients who achieve a partial remission and then went on to receive a transplant. And we think that with this data, our perspective is that we should evaluate whether CAR Ts, compared to an autologous transplant used as consolidation for patients who have a complete response or a partial response, can achieve even better outcomes than those that are achieved by adding a transplant as consolidation. I think that will validate whether adding another type of treatment modalities such as immune cell effector cells for consolidation could provide even better long-term outcomes.

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