Dr. Reeder on Future Treatment Approaches in Aggressive Lymphomas

Craig B. Reeder, MD, assistant professor of Medicine, Mayo Clinic, discusses some future treatment approaches for patients with aggressive lymphomas, including diffuse large B-cell lymphoma (DLBCL).

Reeder hopes that the community are able to use regimens more like an infusion, dose-adjusted regimen of etoposide phosphate, prednisone, vincristine sulfate, cyclophosphamide, doxorubicin hydrochloride, and rituximab (EPOCH-R). Future research should determine whether this regimen, or a novel agent such as lenalidomide (Revlimid) or ibrutinib (Imbruvica), will have a benefit for patients with these high-risk lymphomas, should they turn out to be much more effective.

Additionally, researchers are now able to phenotype the large cell lymphomas into the activated B-cell (ABC) type versus the germinal center B-cell type (GCB) type. Researchers hope that these drugs will be beneficial for each of the subtypes and will represent a more individualized approach.

The 2 subtypes have typically been based on gene expression profiling, Reeder says, adding that it is a tedious process. The various approaches have included immunohistochemistry, the Hans algorithm, and phenotyping either into GCB or ABC. GCB subtypes are likely to have better outcomes with R-CHOP than the non-GCB or ABC types.