Tafasitamab + lenalidomide in R/R DLBCL
Presented by Dr Johannes Düll (University of Würzburg – Germany) & Dr Sarah Bailly (Cliniques universitaires Saint-Luc, Brussels – Belgium)
During this ICML, Dr Bailly (Cliniques Universitaires St-Luc) and Dr Johannes Düll (University of Würzburg) had an interesting discussion around the combination of tafasitamab and lenalidomide, an FDA and EMA-approved treatment for relapsed or refractory diffuse large B-cell lymphoma (DLBCL) in patients who are not candidates for autologous stem cell transplantation (ASCT).
In Belgium, this combination is available as a second-line option for patients who meet these criteria, with particular use in older patients or those with comorbidities or poor performance status. The regimen is well-tolerated, as both tafasitamab, an outpatient infusion, and lenalidomide, an oral medication, are manageable for patients. A key question raised is the sequencing of therapies, particularly whether the use of CD19-targeted therapies might impact future treatments such as CAR-T therapy.
In this context, biopsies of over 60 patients treated with tafasitamab in the relapsed or refractory setting have shown that CD19 expression remains intact, unlike with CAR-T therapies, where CD19 loss occurs in up to 30% of cases. This finding is reassuring, as it suggests that tafasitamab does not diminish the effectiveness of subsequent CD19-based therapies.
Regarding safety, the combination is generally well-tolerated, particularly in older or frail patients. However, lenalidomide, which is part of the combination, is known to cause dose-dependent side effects, including anaemia, thrombocytopenia, and leukopenia. These effects are typically manageable with supportive care such as G-CSF, and once lenalidomide is stopped after about a year, patients generally recover without significant issues. For optimal results, the recommended dose of lenalidomide is 25 mg, and dose reductions are usually not necessary unless kidney function is impaired.
Regarding the sequencing of therapies, particularly in the context of CD19 inhibitors, it is anticipated that further data will emerge in the future to inform the optimal treatment sequence.