Inside the Clinic: Experts Explore Case Studies in DLBCL

Maher Albitar, MD, founder, chief executive officer, chief medical officer, Genomic Testing Cooperative, and Andre H. Goy, MD, physician in chief of the Hackensack Meridian Health Oncology Care Transformation Services, chairman and chief physician officer at John Theurer Cancer Center at Hackensack University Medical Center, and Lymphoma Division Chief at the John Theurer Cancer Center, discuss case studies in diffuse large B-cell lymphoma (DLBCL).

DLBCL is a heterogeneous disease, making subclassification extremely important for proactive clinical decision making, Albitar says. For example, the curability of DLBCL with R-CHOP (rituximab [Rituxan] with cyclophosphamide, doxorubicin, vincristine, and prednisone) goes down in elderly patients, those with a high-risk International Prognostic Index, and those with high-risk molecular subtypes, Goy says.

The stratification of a patient’s risk and ultimate prognosis can be best understood through routine DNA and RNA next-generating sequencing because it can identify chromosomal structural abnormalities and mutations within the germinal cell and activated B-cell–like subtypes. Patients with mutations such as TP53 are often refractory to chemotherapy and need new treatment options. One such option that has been evaluated in the relapsed/refractory setting is the combination of lenalidomide (Revlimid) and rituximab plus ibrutinib (Imbruvica), Goy says.