The term “relapsed” refers to disease that reappears or grows again after a period of remission.
The term “refractory” is used to describe when the lymphoma does not respond to treatment (meaning that the cancer cells continue to grow) or when the response to treatment does not last very long.
High-dose chemotherapy followed by stem cell transplantation can be used to treat patients with DLBCL whose disease is refractory or relapsed following initial chemotherapy. The majority of patients undergoing stem cell transplantation will have an autologous transplant (patient receives his or her own stem cells, collected prior to the procedure). Occasionally, a patient will undergo an allogeneic transplant (patient receives stem cells from a donor).
For those relapsed/refractory patients combination chemotherapy regimens are available. These second-line regimens include:
- ifosfamide, carboplatin, and etoposide (ICE)
- dexamethasone, cisplatin, and cytarabine (DHAP)
- gemcitabine-based therapy
- bendamustine (Treanda) plus rituximab (Rituxan)
- lenalidomide (Revlimid) plus rituximab (Rituxan)
- polatuzumab vedotin-piiq (Polivy)
- selinexor (Xpovio)*
- tafasitamab-cxix (Monjuvi)
*As of June 22, 2020, the U.S. Food and Drug Administration approved selinexor (XPOVIO) for the treatment of adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL), not otherwise specified, including DLBCL arising from follicular lymphoma (FL), after at least 2 lines of systemic therapy.
For some relapsed/refractory patients a form of immunotherapy called chimeric antigen receptor (CAR) T-cell therapy, may be a possible treatment option. The approved CAR T-cell therapies include:
- axicabtagene ciloleucel (Yescarta)
- Lisocabtagene Maraleucel (liso-cel, Breyanzi)
- tisagenlecleucel (Kymriah)
For those relapsed/refractory patients who have a subset of DLBCL called primary mediastinal large B-cell lymphoma (PMBCL). These second-line regimens include:
- pembrolizumab (Keytruda)
To learn more about relapsed/refractory DLBCL, download the Diffuse Large B-Cell Lymphoma Fact Sheet.