A 77-Year-Old Woman with DLBCL - Episode 8
John M. Burke, MD: In regard to this particular patient case example, this was an elderly patient who had relapsed 1 year after completing R-CHOP [rituximab with cyclophosphamide, doxorubicin, vincristine and prednisolone] chemotherapy. The options, in theory, would have included stem cell transplant. Right now, CAR [chimeric antigen receptor] T-cell therapy is only approved as a third-line treatment.
Certainly, there are other chemotherapy regimens that could have been chosen here. This patient would have fit into the L-MIND study criteria, having had relapsed disease and because her physician did not feel that she was transplant eligible based on her age and performance status. I think this was a reasonable choice for this patient. You could use it in the second line, or you could use it as third-line therapy or beyond.
One of the questions about this drug is whether it should be used before CAR T-cell therapy. Why? Well, the drug targets CD19. The theoretical concern is that maybe the targeting of CD19 will remove that protein from the cell, and thereby make the CAR T-cell therapy, which is also targeting CD19, ineffective. Of course, you don’t want to do that.
We don’t have a tremendous amount of data on the answer to that question. There are some in vitro data that were presented at ASH [the American Society of Hematology annual meeting] suggesting that removal of CD19 from the cells probably doesn’t happen. That has been looked at in CLL [chronic lymphocytic leukemia] as well. It does not appear that there’s a big reduction in CD19 on the surface of the cell in CLL after tafasitamab exposure. There have been a few case reports, but not a lot, on successful CAR T-cell therapy after tafasitamab. But again, the data are a bit sparse. That’s one of the theoretical concerns about using tafasitamab in the pre-CAR T-cell therapy space. We don’t yet know the answer, and hope that more data forthcoming will help us understand that impact and relationship better.
Transcript edited for clarity.
Case: A 77-Year-Old Woman With DLBCL