Diffuse large B-cell lymphoma (DLBCL) can be split into separate subtypes depending on the particular cell the lymphoma developed from. The two main subtypes are germinal centre B-cell type (GCB) and activated B-cell type (ABC). These subtypes can behave differently and scientists are investigating whether different treatment approaches work better for different subtypes.
In the REMoDL-B study, people with DLBCL who had not received previous treatment were given one cycle of R-CHOP while their biopsy samples were analysed to work out which subtype of DLBCL they had. They were then randomised to have either:
- five more cycles of R-CHOP
- five cycles of R-CHOP plus bortezomib.
The study found that adding bortezomib to R-CHOP did not improve outcomes in any of the different types of DLBCL. Although this is a ‘negative’ result, it is important to know if drugs are not beneficial to avoid unnecessary treatment. The study did prove that it is possible to use molecular analysis to work out the subtype of DLBCL in real-time. In the future, this might be used to tailor treatment based on the exact subtype of DLBCL a person has.
In a second study, people with non-GCB DLBCL who had not been previously treated were randomised to receive treatment with:
- six cycles of R-CHOP plus ibrutinib
- six cycles of R-CHOP plus placebo.
In people under 60, adding ibrutinib to R-CHOP improved outcomes in people with non-GCB DLBCL with only a small increase in serious side effects. However, in people over 60, adding ibrutinib to R-CHOP caused a significant increase in serious side effects. Because of this, fewer people over 60 who received ibrutinib were able to complete all six cycles of treatment, leading to worse outcomes.
The study concluded that adding ibrutinib to R-CHOP in younger people with non-GCB DLBCL is promising. Further studies are needed to confirm the results.
Taken together, these studies show the potential of using specific characteristics, such as molecular subtyping and age, to tailor treatment to the individual.
7 May 2019