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Hematologic Malignancies • Medical Oncology • Lymphoma • NCI-CCC Tumor Board Question • Internal Medicine • Hematology • CNS Disease • UC Irvine • NCI-CCC Lymphoma Tumor Board Question • DLBCL
How would you consolidate a patient with primary refractory double hit lymphoma with secondary CNS involvement?
At the time of initial diagnosis, there was no clear CNS involvement. When it became clinically apparent disease was refractory to EPOCH, there was CSF involvement. Now clinically responding to R-DHAOx. Would you extrapolate from studies like ZUMA-7 and TRANSFORM and go to CART, or consider thiotepa-based auto if CR is achieved? Limited co-morbidities and excellent performance status.
Answer from: at Academic Institution
Thiotepa-based transplants are particularly rough. We haven't had good outcomes with them in terms of relapse and mortality is much higher than BEAM or Mel autos.Having said that, this patient has chemo-refractory disease. The initial concern with CAR-T in primary CNS or secondary involvement was th...
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Answer from: Medical Oncologist at Academic Institution
I would extrapolate from the 2L CAR-T trials and will offer CAR-T therapy assuming that his CNS disease is relatively under control.