Bridging to Transplant in Diffuse Large B Cell Lymphoma

Abstract

Non-Hodgkin lymphoma (NHL) is the eighth most common malignancy worldwide. Diffuse large B cell lymphoma (DLBCL) is the most frequent subtype, accounting for >30% of NHL cases. Advances in novel approaches in the last two decades, such as immunotherapy with rituximab, have achieved improvements in terms of overall and long-term survival rates. The current standard of care for the first-line treatment of DLBCL is chemotherapy with rituximab plus cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisolone; this regimen achieves complete and sustained remission in approximately 60% of patients. Nevertheless, DLBCL relapses in 30–40% of patients, of which 10% develop refractory disease. Recent findings have demonstrated that substantial responses could be achieved after second or third-line treatments with combined chemotherapy. Since 2012, the aza-anthracenedione, pixantrone, has been approved as a single agent for relapsed or refractory DLBCL. The drug could be a new option as a bridging therapy to consolidate autologous or allogeneic stem cell transplantation, which in turn, can deliver prolonged durations of remission. Numerous clinical studies are ongoing that aim to improve salvage rates, outcomes, and access to stem cell transplantations for relapsed or refractory DLBCL. The development of novel targeted therapies or chemotherapeutics, such as pixantrone, will help to salvage more patients and achieve further sustained and complete responses without compromising their quality of life.