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).
Transcript
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.
Related Videos
The ASCO Post Staff
Stephen M. Ansell, MD, PhD, and Patrizia Mondello, MD, PhD, both of the Mayo Clinic, discuss the 20% of patients with follicular lymphoma (FL) who relapse early and experience a poor prognosis. The researchers found that FLs with high levels of IRF4 expression are associated with a suppressive tumor microenvironment, and selective IRF4 silencing restores antilymphoma T-cell immunity. Further investigation is warranted to identify the mechanisms by which IRF4 controls tumor immunity to develop precision therapies for this population (Abstract 70).
The ASCO Post Staff
Anand P. Jillella, MD, of Georgia Cancer Center at Augusta University, discusses results from the ECOG-ACRIN EA9131 Trial, which showed that using a simplified treatment algorithm and management recommendations made by a group of specialists, resulted in a dramatic improvement in 1-year survival of patients with acute promyelocytic leukemia (Abstract 421).
The ASCO Post Staff
Paul G. Richardson, MD, of the Dana-Farber Cancer Institute, discusses preliminary results from the dose-expansion phase of the CC-92480-MM-001 Trial, which showed promising efficacy in patients with relapsed and refractory multiple myeloma, including those with prior BCMA-targeted therapies. Patients in these two groups had an overall response rate of 40% and 50%, respectively. The results support the development of mezigdomide, currently being evaluated in combination with standard therapies in multiple myeloma as part of a large, ongoing phase I/II trial (NCT03989414) and planned phase III studies (Abstract 568).
The ASCO Post Staff
Kathryn R. Tringale, MD, of Memorial Sloan Kettering Cancer Center, discusses an assessment of 559 patients with primary central nervous system (CNS) lymphoma and the factors associated with consolidation therapy selection, outcomes after consolidation therapy accounting for patient factors, and patterns of disease failure. The initial treatment response was prognostic and predictive of relapse patterns (Abstract 557).
The ASCO Post Staff
Eva Hoster, PhD, of Munich University, discusses results from the European MCL Elderly Trial, which confirmed the strong efficacy of rituximab maintenance in minimal residual disease (MRD)-negative patients with mantle cell lymphoma (MCL) after induction. Omitting maintenance based on MRD-negativity is thus discouraged. Considering the short time to progression, more effective treatment strategies should be explored in MRD-positive patients to improve long-term prognosis (Abstract 544).