Considerations in relapsed/refractory patients

• Patients with partial response, stable disease, or progressive disease (response criteria Tables 8 and 9) are treated as relapsed/refractory patients.^25,47 Response criteria have been revised to include PET assessment.²⁵ For more information on the potential use of PET scanning to inform treatment decisions, refer to the Current issues in DLBCL section
• Patients are evaluated to determine whether or not they are candidates for high-dose therapy based on risk factors⁴⁷
• Patients who are candidates for high-dose therapy who receive a second-line chemotherapy regimen and respond, may undergo any of the following^25,49:
  • Autologous stem cell transplant with or without involved field radiation therapy²⁵
  • Allogeneic stem cell transplant in selected cases, which include patients with mobilization failures and persistent bone marrow involvement²⁵
  • If these patients relapse again, they may be enrolled in a clinical trial⁴⁹
• When patients are not candidates for high-dose therapy, they are considered for clinical trials, additional second-line therapies, or palliative radiation therapies⁴⁹

Table 8. Response criteria for lymphoma (not including PET).⁵⁰

Table 9. Response criteria for lymphoma (including PET).⁵¹

• Improvements in risk assessment strategies in the relapsed/refractory setting are necessary to personalize treatment selection in the second-line setting⁴⁷
  • None of the first-line prognostic molecular markers nor cell-of-origin classifications relate to survival outcome of DLBCL patients in the second-line setting (Figure 6)
  • New prognostic and predictive molecular markers for outcomes in the second-line setting are current areas of research

Figure 6. Cell of origin does not influence overall survival in second-line treatment of DLBCL.⁴⁷

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