Examining Factors to Consider in the Treatment of Patients With Indolent B-Cell Lymphomas

Gilles Salles, MD, PhD, Memorial Sloan Kettering Cancer Center, New York, New York, offers his advice for fellow oncologists in the B-cell lymphoma space, spotlighting the need for carefully and strategically chosen therapies to minimize the risk of transformations when treating this patient population.

Transcript: 

Dr Gilles Salles: My name is Dr Gilles Salles. I am from Memorial Sloan Kettering Cancer Center in New York. 

Oncology Learning Network: What advice do you have for fellow oncologists treating patients with follicular lymphoma, diffuse large B-cell lymphoma, and/or other indolent B-cell lymphomas? 

Dr Gilles Salles: Nowadays, we do know that there are multiple options, [such as] rituximab single agent, rituximab maintenance, [and] obinutuzumab. More recently, bispecific antibodies and [chimeric antigen receptor] (CAR) T cells. Even if [phosphoinositide 3] (PI3) kinase is not available, at least the oral one, we also have tazemetostat. 

But, just [to] bring it very easily, we should not harm those patients. Those patients will experience a prolonged survival. Only a few of them will have really threatening conditions that may lead to death. The first one is obviously histologic transformation. One of the key messages is that any time a patient with indolent lymphoma experiences a disease relapse, [or] a disease progression, it's important to do a new biopsy to eliminate or identify these patients that have transformation because they should go to a different pathway of treatment close to the one we do for diffuse large B-cell lymphoma. 

Then, I think these patients should be managed sometimes expectedly. We don't have to restart chemotherapy in all patients that progress. But, as shown in [the phase 3 SELENE trial], using a second line of therapy brings a benefit to the majority of patients. 

Other group[s] of patients that have been identified as patients with early progression after chemo immunotherapies, [and] they have a worse outcome. So [in] part, an essential part of this worst outcome is associated with the risk of transformation. 

Again, [as a] take-home message, always think that transformation is a threat for those patients. Otherwise, try to manage these patients without harming them using either chemotherapy, immunotherapies, [or] the new tools that are available, and hop[e] to prolong their survival. The median overall survival is probably in the range of 20 years right now without harming them with too many treatments. 

Source:

Nastoupil LJ, Hess G, Pavlovsky MA, et al. Phase 3 SELENE study: ibrutinib plus BR/R-CHOP in previously treated patients with follicular or marginal zone lymphoma. Blood Adv. Published online: September 18, 2023. doi: 10.1182/bloodadvances.2023010298