Interactive Case Study
Patient 82 Y/O Diagnosed With LBCL
Interactive Case Study
Patient 82 Y/O Diagnosed With LBCL
Patient
82-year-old Caucasian male
NSTEMI five years ago
3×DES implant
Comorbidities:
- AV block grade I
- Mild mitral valve insufficiency
- DVT
Diagnosed with DLBCL, Ann Arbor stage II
Bulky disease with left inguinal lymph node mass of 20×10×9 cm
- GCB subtype
- Massive leg swelling and DVT
- ECOG PS 1, IPI score 2
- Elevated LDH
This material has been developed and funded by Gilead Sciences. Intended for HCPs only. Adapted patient case from Prof. Dr Marion Subklewe. This patient was based and treated in Germany.
1L, first-line; AV, atrioventricular; DES, drug-eluting stent; DLBCL, diffuse large B-cell lymphoma; DVT, deep vein thrombosis; ECOG PS, Eastern Cooperative Oncology Group performance status; GCB, germinal centre B-cell; IPI, International Prognostic Index; LDH, lactate dehydrogenase; NSTEMI, non–ST-segment elevation myocardial infarction.
What is your first choice for 1L treatment?
R-CHOP rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone | R-mini-CHOP | R- CEOP (rituximab, cyclophosphamide, hydroxydaunomycin, vincristine sulfate | R – CVP rituximab, cyclophosphamide, vincristine, prednisone
In this case study
R-mini-CHOP, 4 cycles was chosen as 1L treatment
Continuous anticoagulant therapy
After 4 cycles of R-mini-CHOP: PR
18F-FDG PET-CT scans two months after 4 cycles of R-mini-CHOP
• Deauville score 5 • Bulky disease
- DLBCL, Ann Arbor stage IV
- ECOG PS 2*, IPI score 4
- No secondary CNS lymphoma, no CNS disease,
no autoimmune disease - Hypertension, hypercholesterolaemia
- Mild renal impairment (CrCl 60 mL/min)
- Extranodal disease, leg infiltration; massive swelling of the leg
- NYHA class III; sinus bradycardia
- Stress MRI: EF 69%; stress-induced ischaemia within the LAD artery affecting >10% of the myocardium
- Benign prostatic hyperplasia
1L, first-line; AV, atrioventricular; DES, drug-eluting stent; DLBCL, diffuse large B-cell lymphoma; DVT, deep vein thrombosis; ECOG PS, Eastern Cooperative Oncology Group performance status; GCB, germinal centre B-cell; IPI, International Prognostic Index; LDH, lactate dehydrogenase; NSTEMI, non–ST-segment elevation myocardial infarction.
1L, first-line; 18F, fluorine-18; CT, computed tomography; DLBCL, diffuse large B-cell lymphoma; FDG, fluorodeoxyglucose; PD, progressive disease; PET, positron emission tomography;
PR, partial response; R-mini-CHOP, rituximab + reduced-dose cyclophosphamide + doxorubicin hydrochloride + vincristine + prednisolone.
Patients with inadequate renal, hepatic, pulmonary or cardiac function are likely to be more vulnerable to the consequences of the adverse reactions to Yescarta® and require special attention. Please refer to the Yescarta® SmPC for more information. 1L, first-line; 2L, second-line; CNS, central nervous system; CrCl, creatinine clearance; CT, computed tomography; DLBCL, diffuse large B-cell lymphoma; ECOG PS, European Cooperative Oncology Group performance status; EF, ejection fraction; IPI, International Prognostic Index; LAD, left anterior descending; LDH, lactate dehydrogenase; MRI, magnetic resonance imaging; NYHA, New York Heart Association; PET, positron emission tomography.
1. Westin JR, et al. Clin Cancer Res 2023;29:1894–1905; 2. Houot R, et al. Nat Med 2023;29:2593–2601.
What is your choice for further treatment?
In this case study
Yescarta® was chosen as 2L treatment
Based on efficacy evidence in patients with advanced age and well-managed comorbidities1,2
Treatment Timeline: Yescarta®
Adverse events during hospitalisation following Yescarta®
Were manageable
Delay between leukapheresis and Yescarta® infusion due to re-assessment of cardiac function (Oct 2020). Patients with inadequate renal, hepatic, pulmonary or cardiac function are likely to be more vulnerable to the consequences of the adverse reactions to Yescarta® and require special attention. Please refer to the Yescarta® SmPC for more information. 2L, second-line; CAR T, chimeric antigen receptor T-cell; FluCy, fludarabine + cyclophosphamide; PD, progressive disease;
R-mini-CHOP, rituximab + reduced-dose cyclophosphamide + doxorubicin hydrochloride + vincristine + prednisolone.
*Physician’s choice, as per institutional protocol. No interaction studies have been performed with Yescarta®. Please refer to individual products' summary of product characteristics for full information.
AE, adverse event; CAR T, chimeric antigen receptor T-cell; CRS, cytokine release syndrome; G-CSF, granulocyte colony-stimulating factor; ICAHT, immune effector cell-associated hematotoxicity; ICANS, immune effector cell-associated neurotoxicity syndrome; ICE, immune effector cell-associated encephalopathy; ICU, intensive care unit; RR, respiration rate.
Treatment outcomes
18F-FDG PET-CT scans following infusion with Yescarta® as 2L
3 MONTHS
post Yescarta® infusion
Deauville score 2
CR
after
3
MONTHS
12 MONTHS
post Yescarta® infusion
Deauville score 2
Duration of response:
21
MONTHS
The patient succumbed to COVID-related pneumonia 658 days post CAR-T infusion while in complete remission
Take-home messages
This case presented many challenges:
- Advanced age (82 years at diagnosis)
- Refractory disease
- Transplant ineligible
- Multiple comorbidities
- Poor performance status
Factors which may have contributed to the outcomes:
- 2L treatment choice: Yescarta®
- Patient ineligible for transplant due to advanced age and comorbidities
- Evidence suggests patients with R/R DLBCL who are aged ≥65 years,1 or who are ineligible for transplant, 2,3 can benefit from CAR-T therapy
- Responded to CAR-T therapy for 21 months with manageable AEs
- Patients aged ≥70 years relapsing within 12 months can be considered for
CAR-T therapy despite transplant ineligibility - The patient succumbed to COVID-related pneumonia 21 months post
CAR-T while in complete remission
This is a case presentation. Individual results will vary. Images provided with permission by speaker. 18F, fluorine-18; CT, computed tomography; FDG, fluorodeoxyglucose; PET, positron emission tomography.
This is a case presentation. Individual results will vary. Patients with inadequate renal, hepatic, pulmonary, or cardiac function are likely to be more vulnerable to the consequences of the adverse reactions and require special attention. 1L, first-line; 2L,
second-line; AE, adverse event; CAR T therapy, chimeric antigen receptor T-cell therapy; DLBCL, diffuse large B-cell lymphoma; R/R, relapsed/refractory; R-mini-CHOP, rituximab + reduced-dose cyclophosphamide + doxorubicin hydrochloride + vincristine +
prednisolone. 1. Westin JR, et al. Clin Cancer Res 2023;29:1894–1905; 2. Houot R, et al. Nat Med 2023;29:2593–2601; 3. Vic S, et al. Eur J Cancer 2022;175:246–253.
IL-YES-0184, DEC 24
Yescarta is indicated for the treatment of adult patients with diffuse large B-cell lymphoma (DLBCL) and high-grade B-cell lymphoma (HGBL) that relapses within 12 months from completion of, or is refractory to, first-line chemoimmunotherapy.
Yescarta is indicated for the treatment of adult patients with relapsed or refractory (r/r) diffuse large B-cell lymphoma (DLBCL) and primary mediastinal large B-cell lymphoma (PMBCL), after two or more lines of systemic therapy.
Limitation of Use: Yescarta is not indicated for the treatment of patients with primary or secondary central nervous system lymphoma. Yescarta is indicated for the treatment of adult patients with relapsed or refractory follicular lymphoma (FL) after two or more lines of systemic therapy.
The pictures on the website are for illustration purposes (AI generated).
For further information and full list of adverse events, please refer to the approved prescribing information as available at Israeli Ministry of Health website : https://israeldrugs.health.gov.il/#!/byDrug
Report an AE https://www.gileadisrael.co.il/utility/contact
This casestudy is intended for healthcare providers only
For any further questions please contact: medinfo.israel@gilead.com
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