Treatment Options For Relapsed Or Refractory Diffuse Large B-Cell Lymphoma
- New Hope After Relapse: Even when diffuse large B-cell lymphoma doesn’t respond to chemotherapy or returns after treatment, newer immune-based therapies like CAR T-Cell Therapy and bispecific antibodies are offering patients lasting control and improved quality of life.
- Personalized Treatment Options: Doctors can now tailor care based on each patient’s disease and situation — with options ranging from targeted immunotherapies to stem cell transplants and salvage chemotherapy.
- Whole-Person Care Matters: Open communication, emotional support, and sharing daily goals with your care team help ensure treatment plans fit your life and needs.
“Even in patients where treatments are failing or have not worked previously, we have targeted approaches that can be made specific for that patient’s disease, which is very exciting because it generally presents better control of disease,” Dr. Krushangi Patel, an oncologist at City of Hope Cancer Center in Long Beach, California, tells SurvivorNet.
Read MoreTherapy Options After Relapse
For most people diagnosed with DLBCL, chemotherapy is the first line of treatment — and it’s often very effective. But, in some cases, the lymphoma doesn’t respond as expected, or it returns after an initial remission. “Our first-line therapies, if risk-stratified appropriately, often lead to remission that can be sustained” Dr. Patel explains. “When we have patients that do not respond to first-line chemotherapy, we start thinking about other options.”These include:
- CAR T-Cell Therapy: This treatment uses your own T-cells, which are reprogrammed to attack lymphoma. It is given as a one-time infusion, although it takes time to prepare and is only available at specialized, large centers. CAR T-Cell Therapy is often preferred for refractory lymphoma and is highly effective. It is approved for disease that has not responded to chemotherapy or returns within 12 months, or after two or more prior treatments.
- Bispecific antibodies: This is another non-chemotherapy option that redirects your immune system to attack lymphoma. They are given as ongoing outpatient infusions, making them faster and more accessible than CAR T-Cell Therapy, and the side effects are often more manageable. Because they are “off-the-shelf” therapies, they do not need to be manufactured from your own cells and are often considered for patients who cannot access or are ineligible for CAR T or for use after CAR T, if needed.
- Salvage chemotherapy: This approach may also be effective, particularly for patients whose lymphoma relapsed after a longer remission, and can serve as a bridge to other therapies such as CAR T or stem cell transplant.
- Autologous stem cell transplant: This involves an infusion of high-dose chemotherapy followed by rescue with your own stem cells to restore blood cell and immune cell production, and remains an option for patients who respond well to chemotherapy. This was more commonly used prior to the development of CAR T therapy.
“CAR T therapy and bispecific antibodies are exciting because they allow long-term control of disease and maintain quality of life. We can often give these treatments close to home and help patients get back to work and family life within weeks,” Dr. Patel explains.
What the Data Shows
The Findings on CAR T-Cell Therapy
- According to data from the ZUMA-1 study — which evaluated a CAR T-Cell Therapy product called axicabtagene ciloleucel (axi-cel) that is used to treat diffuse large B-Cell lymphoma patients — 82% of patients saw their lymphoma shrink, and 54% went into complete remission.
- Another study, TRANSCEND, looked at a different product called lisocabtagene maraleucel (liso-cel) and found 73% of diffuse large B-cell lymphoma patients had their lymphoma shrink, with 53% achieving a complete remission.
- For patients with diffuse large B-cell lymphoma whose cancer hasn’t responded to previous treatments or has come back, these results are extremely encouraging — showing that CAR T-Cell Therapy can offer meaningful and often long-lasting remission when few other options remain.
The Findings on Bispecific Antibodies
- According to data from the EPCORE NHL-1 study that looked at diffuse large B-cell lymphoma patients who were treated only with bispecific antibodies, the overall response rate was 63.1% and complete response (CR) rate was 40.1%.
Understanding Bispecific Antibodies and How They Differ From CAR T-Cell Therapy
Managing Stress & Expectations
It’s normal to feel overwhelmed or exhausted after prior therapy — and scared that cancer is not responding or has returned. But there are still options and your care team can guide you toward therapies that control your disease and preserve quality of life. Understanding side effects, timelines, and logistics can help you prepare emotionally and practically. Being open with your care team about your goals is imporant.
“When you go to meet a specialist, share what your normal is like, your daily activities, nutrition, and energy level. That helps your doctor plan a treatment that fits your life,” Dr. Patel explains.
Try This Simple, Guided Grounding Exercise to Help Manage Anxiety
Questions To Ask Your Doctor
- What treatments are available? Which are likely to control my disease?
- What should I expect immediately after treatment and in the weeks or months ahead?
- How long might this treatment control my lymphoma? Could it lead to a cure or long-term remission?
- How will treatment affect daily activities, energy, and nutrition?
- Where will treatment occur? Will I need to be away from home?
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