The Evolving Role of Radiation Therapy in DLBCL: From Early-Stage to Refractory Disease

doi:10.46883/2022.25920980

Cited by 4 publications

(5 citation statements)

References 5 publications

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“…As incident DLBCL is more commonly treated in combination with chemotherapy, patients who received monotherapy may have been older and presented with more comorbidities and therefore were unable to tolerate a full chemotherapy regimen [ 40 ]. Few patients (2.4%) received radiation therapy alone, likely as a treatment for localized disease [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and Real-World Treatment of Incident Diffuse Large B-cell Lymphoma (DLBCL): A German Claims Data Analysis

Pacis,

Bolzani,

Heuck

et al. 2024

Oncol Ther

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Introduction The objective of this study was to investigate the prevalence, incidence, and treatment patterns (treatment regimens, switches, duration) for diffuse large B-cell lymphoma (DLBCL) in a real-world setting. Methods This was a retrospective German claims data analysis of patients with DLBCL diagnosed between January 1, 2012, and December 31, 2020. The prevalence and cumulative incidence of DLBCL were found for 2019/2020. Line of treatment (LOT) and treatment setting from first DLBCL diagnosis to end of follow-up were described. Kaplan–Meier overall survival (OS) estimates since DLBCL diagnosis and start of treatment lines were calculated. Results Overall, 2633 incident DLBCL cases were identified (median age 75 years, 51% male). Of these, 2119 patients received at least one DLBCL-related treatment (LOT1), and 1567 patients died during follow-up. In 2019/2020, the prevalence and cumulative incidence of DLBCL was 34.8/36.7 per 100,000 patients and 14.0/12.7 per 100,000 patients, respectively. For LOT1, 1922 patients were given a chemotherapy-based regimen (1530 with CD20 antibodies). A total of 403 patients were administered a second line (LOT2), of which 183 patients received a CD20 antibody-containing chemotherapy regimen and 100 patients received stem cell transplantation or chimeric antigen receptor (CAR)-T therapy. Of the 136 LOT3+ treatments, 74 were chemotherapy regimens (54 with CD20 antibodies) and 18 were kinase inhibitors. The median time between treatment lines was less than 6 months. Among patients with at least LOT2, approximately 50% received more than one LOT during the first year after diagnosis. Approximately 25% of treated patients died within 6 months of treatment initiation. Of the 2633 included patients, the median OS from diagnosis was 31.0 months (treated patients: 46.8 months, untreated patients: 3.0 months). Conclusions Despite advances in the field, high unmet medical need in DLBCL remains. The treatment landscape is very heterogeneous, particularly in second- or later-line treatments, with few patients receiving potentially curative treatment beyond the first line. Treatment for DLBCL, particularly for transplant-ineligible patients, remains challenging. Supplementary Information The online version contains supplementary material available at 10.1007/s40487-024-00265-8.

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Section: Discussionmentioning

confidence: 99%

Epidemiology and Real-World Treatment of Incident Diffuse Large B-cell Lymphoma (DLBCL): A German Claims Data Analysis

Pacis,

Bolzani,

Heuck

et al. 2024

Oncol Ther

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“…As it has been investigated for ASCT, with CAR-T cell treatments the correct order to offer radiotherapy has also been under investigation [ 12 ]. This is, nevertheless, a growing application for radiotherapy [ 13 ] and new, prospective data is needed.…”

Section: Discussionmentioning

confidence: 99%

Results of consolidative radiotherapy for relapsed diffuse B-Cell lymphoma

Mauro,

Ribeiro Neto,

Carvalho

2023

Rep Pract Oncol Radiother.

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Background Recurrent diffuse large B-cell lymphoma (DLBCL) is a disease with high mortality. The standard of care involves autologous stem-cell transplantation (ASCT), which is not always feasible. We investigated the impact of radiotherapy as part of the salvage treatment for patients with relapsed disease. Materials and methods Retrospective study of patients with recurrent DLBCL after chemotherapy and consolidative radiotherapy at a single institution. All patients were included if radiation was part of the first treatment. Results Of 359 patients assessed between 2010 and 2017, 65 (18.1%) presented a recurrence, but only 62 received further treatment and were included in the study. Mean overall survival was 18.6 months since diagnosis and progression-free survival after first progression (PFS2) was 7.7 months. Patients were divided into two groups according to whether they did (24.8%) or did not (75.8%) receive radiation as part of their salvage treatment. Patients that did not receive R-CHOP (rituximab plus cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisone) in the first line were treated more with radiation in the second line (p = 0.02). Six patients with in-field relapse were re-irradiated. Only 4 patients received ASCT as part of their treatment for relapsed disease. There was no difference in outcomes. Conclusion There is a place for radiotherapy in the treatment of relapsed DLBCL, particularly when patients do not receive ASCT. Radiotherapy is well-tolerated. More trials to assess the role of radiotherapy for these patients are needed.

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“…Irrespective of indication, a dose of 30-36 Gy was frequent and consistent with current recommendations for consolidation in patients who have achieved CMR on PET. 14 Further, radiotherapy needs to be implemented with caution due to the risk of secondary malignancy, in particular gastric adenocarcinoma. 33 One strategy to minimise late toxicity due to radiotherapy may be to limit field size, shown to be of benefit for the management of gastric marginal zone lymphoma.…”

Section: -85 71-100mentioning

confidence: 99%

“…11,12 Radiotherapy may be a routine in some centres or reserved for cases of bulky or refractory disease. 13,14 Surgical intervention is generally limited to cases complicated by perforation, gastric outlet obstruction or uncontrollable gastrointestinal bleeding due to its high mortality rate. 15 Outcomes for PG-DLBCL appear favourable, with a series of 272 patients estimating 3-year progression-free survival (PFS) and overall survival (OS) rates of 77% and 81% respectively.…”

Section: Introductionmentioning

confidence: 99%

Primary gastric diffuse large B‐cell lymphoma: A multicentre retrospective study

Lewis,

Joy,

Jensen

et al. 2024

Br J Haematol

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SummaryPrimary gastric diffuse large B‐cell lymphoma (PG‐DLBCL) accounts for the majority of extra‐nodal DLBCL. Even so, literature is lacking on early, localised presentations. We studied a cohort of patients with stage I disease, diagnosed between 2006 and 2018, from six centres between Australia, Canada and Denmark. Our goal was to characterise outcomes, review treatment and investigate the role of interim positron emission tomography (iPET). Thirty‐seven eligible patients were identified. The median duration of follow‐up was 42.2 months. All received chemoimmunotherapy with 91.9% (n = 34) given rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R‐CHOP). 35.1% (n = 13) underwent consolidative radiotherapy. Eighteen patients were H. pylori positive and 11 had the documentation of H. pylori eradication therapy. The 4‐year progression‐free survival and overall survival of R‐CHOP was 88% (95% CI: 71–95) and 91% (95% CI: 75–97) respectively. All patients who achieved a partial metabolic response or complete metabolic response on iPET went on to achieve complete response at the end of treatment. R‐CHOP‐based therapy with iPET assessment appears to offer favourable outcomes, with radiotherapy and H. pylori eradication therapy implemented on a case‐by‐case basis.

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The Evolving Role of Radiation Therapy in DLBCL: From Early-Stage to Refractory Disease

Cited by 4 publications

References 5 publications

Epidemiology and Real-World Treatment of Incident Diffuse Large B-cell Lymphoma (DLBCL): A German Claims Data Analysis

Epidemiology and Real-World Treatment of Incident Diffuse Large B-cell Lymphoma (DLBCL): A German Claims Data Analysis

Results of consolidative radiotherapy for relapsed diffuse B-Cell lymphoma

Primary gastric diffuse large B‐cell lymphoma: A multicentre retrospective study

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