New developments in B cell lymphoma

Recently, several new therapeutic developments have led to potentially important changes in B cell lymphoma management. For the most common lymphoma subtype, diffuse large B cell, phase III randomized trials have suggested that the substitution of polatuzumab vedotin for vincristine in the standard R-CHOP chemoimmunotherapy regimen can improve progression-free survival without significant additional toxicity. Chimeric antigen receptor T (CAR-T) cell therapy appears to have important benefits in the second-line therapy (vs chemoimmunotherapy and autologous stem cell transplant) setting. A number of novel agents also appear to have value in the relapsed disease situation and are being tested in a variety of scenarios. While anti-CD20 based therapy (with or without chemotherapy) is standard in follicular lymphoma, the second most common lymphoma subtype, the addition of lenalidomide to rituximab offers both a progression-free and overall survival benefit in patients with relapsed disease. Novel agents continue to be explored in this area. In mantle cell lymphoma, recent data have expanded the role of Bruton’s tyrosine kinase inhibitors in both upfront and relapsed disease, and the role of high dose chemotherapy and autologous stem cell transplant is now even more questionable vs other less intensive approaches. CAR-T cell-based approaches also are important in mantle cell lymphoma particularly in patients with multiply recurrent disease. A common theme across the B cell lymphoma treatment landscape is the desire for more rational choice of therapy (based on disease biology, clinical characteristics, and patient preferences) as well as the optimal implementation of exciting novel agents moving into the clinic.