John M. Burke, MD

Case Overview: 77-Year-Old Woman With DLBCL

Approaching DLBCL: Risk Assessment and Prognosis

DLBCL: Cytogenetic Testing and Treatment Initiation

Frontline Treatment Approaches in DLBCL

Current Treatment Approaches for R/R DLBCL

Implications for Treating R/R DLBCL With the L-MIND Regimen

R/R DLBCL: Observations From the Re-MIND Study

R/R DLBCL: Treating With Tafasitamab Plus Lenalidomide

Progress Made in Treating R/R DLBCL

A 77-year-old woman presented with loss of appetite, fatigue and shortness of breath

PMH: post-menopausal; DM, medically controlled

PE: palpable inguinal lymphadenopathy; splenomegaly

Core needle biopsy of the inguinal node: CD20-positive diffuse large B-cell lymphoma, non-GCB subtype. FISH panel: t(14;18) with a BCL2 rearrangement; no MYC or BCL6 rearrangement

Whole body PET/CT scan showed FDG avidity the inguinal lymph node region, largest node 3.3 cm; splenomegaly; and a small suspicious lung lesion

Bone marrow biopsy: involvement with DLBCL

Conclusion: stage IV DLBCL, non-GCB subtype

IPI score high-risk; CNS relapse score intermediate risk

End-of-treatment PET/CT demonstrates a Deauville 2 complete remission

1 year later while in surveillance she presents with new cervical, axillary, mediastinal, and abdominal lymphadenopathy

Core needle biopsy of an axillary node confirms a relapse of DLBCL, non-GCB subtype

Based on her age of 78 years and performance status, you consider her to be transplant-ineligible

You elect to initiate tafasitamab + lenalidomide

Videos

John M. Burke, MD, of Rocky Mountain Cancer Centers, explains the rationale behind treating an elderly woman with relapsed diffuse large B-cell lymphoma with tafasitamab and lenalidomide after R-CHOP chemotherapy.

A 77-Year-Old Woman with DLBCL

John M. Burke, MD, associate chair of the Hematology Research Program for US Oncology and medical oncologist and hematologist at Rocky Mountain Cancer Centers, discusses treatment with rituximab (Rituxan) versus obinutuzumab (Gazyva) in patients with advanced stage follicular lymphoma with high tumor burden.

Burke says that generally, for this patient population, most physicians will treat them with chemoimmunotherapy, but there are differences among practice for whether they will choose rituximab or obinutuzumab for immunotherapy and bendamustine (Bendeka), cisplatin, or CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) for chemotherapy.

In practice, Burke usually uses obinutuzumab because of the data from the GALLIUM trial (NCT01332968). This study showed obinutuzumab had a longer progression-free survival than rituximab for patients with previously untreated advanced stage follicular lymphoma when both were combined with chemotherapy. He says although that’s his personal choice, it is a less common choice than rituximab in this setting because there’s no known survival advantage with obinutuzumab over rituximab, and there’s some added toxicity with obinutuzumab for this patient population. There are physicians who have been using rituximab longer and are more comfortable with it and have decided to continue using it in their practice.

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John M. Burke, MD, discusses treatment with rituximab versus obinutuzumab in patients with advanced stage follicular lymphoma with high tumor burden.


Author | John M. Burke, MD

Articles

A 77-Year-Old Woman with DLBCL

Deciding on Rituximab Versus Obinutuzumab in Follicular Lymphoma