Single-Route Prophylaxis in Aggressive B-Cell Lymphomas

Victor Orellana-Noia, MD, Assistant Professor of Hematology and Medical Oncology at the Winship Cancer Institute at Emory University, presented a poster titled, “Multicenter Retrospective Analysis of Single-Route Prophylaxis in Aggressive B-Cell Lymphomas” at the 10th Annual Society of Hematologic Oncology (SOHO) Meeting. He discussed his findings with Blood Cancers Today.

What question were you trying to answer in your study?

We did a 21-center review of about 1,100 patients who had received central nervous system (CNS) prophylaxis for diffuse LBCL. The question we were trying to answer was, “Does the route of administration matter in preventing CNS relapse?”

There are a number of differences in the patient populations that receive a given route, and there are some theoretical differences in how each one might prevent a CNS relapse. It is a challenging clinical area to run a phase III clinical trial, but we tried to do a more robust chart review. Ultimately, we found no difference between the two routes of administration.

I know there are some limitations, but I think the bigger question that we have to answer in the space more broadly doesn’t have to do with how we administer methotrexate, be it intrathecally or systemically, it’s more how we can do more biologically directed therapy to improve outcomes overall.

What are some key areas that hold promise in this field? 

Everyone is excited about CAR-T therapy. There’s also a number of very clear barriers to who can get CAR-T in a timely fashion. I think what we need to have more of is not necessarily cellular therapies that are autologous in nature, but off-the-shelf therapies, via CAR-T, bispecifics, etc. We need to be developing these agents for patients with aggressive disease, who don’t have time to wait through all the hurdles of apheresis and manufacturing. At the same time, fitness requirements for these newer classes won’t necessarily track with our conventional criteria for autologous transplant, so we need to keep that firmly in mind when deciding how strict our eligibility criteria have to be so that we’re appropriately safe and appropriately inclusive.

What do you see as being next in the treatment realm for your patients? 

The class of agents I’m most excited about in large-cell lymphoma is bispecific T-cell engagers. There are a number of agents targeting CD20. We know CD20 has been a very valuable target for years, since rituximab came around. But to be able to have a T-cell engager that targets it, we’re seeing some really promising early-phase data. I’m excited to see what the later-phase data show.