Diffuse Large B Cell Lymphoma and Primary Mediastinal Lymphoma

Abstract

AbstractThe outcome of patients with large B cell lymphoma (LBCL) who did not respond to a classical immunochemotherapy regimen at any time or relapsed within 1 year following chemoimmunotherapy is poor. The Scholar-One-Study showed long-term event-free survival for less than 20% of these patients (Crump et al. 2017). The introduction of chimeric antigen receptor T cell therapy (CAR-T) is a substantial advancement for these patients, offering long-term remission and a curative prospect for 30 to 40% of patients (summarized in Table 12.1), (Abramson et al. 2020; Neelapu et al. 2017; Schuster et al. 2019b). To date, in Europe, two products (axicabtagene ciloleucel and tisagenlecleucel) have been licenced by the European Medical Agency, and a third product (lisocabtagene maraleucel) will become available in 2021. All these products are licenced for patients who have failed at least two prior lines of systemic therapy. This initially defines, however broad, a range of possible situations in which the application of CART is indicated. The following considerations may help to further define the patient population that should be offered CAR-T cells as the next line of treatment. Studies addressing the potential benefit of CAR-T cells compared to high-dose chemotherapy and autologous stem cell transplantation for second-line treatment of LBCL have been fully recruited, but the results are still pending.