New approaches show promise for high-grade non-Hodgkin lymphoma

Becky, our senior medical writer, looks at new approaches for high-grade non-Hodgkin lymphoma, discussed at the ASH meeting in December. 

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The ASH (American Society of Hematology) meeting in December is the largest gathering of lymphoma experts worldwide. In January, UK experts met in London to talk about the latest developments presented at ASH and their implications for clinical practice in the UK.

High-grade (fast-growing) non-Hodgkin lymphoma (NHL) is particularly challenging to treat if it relapses (comes back). Encouraging results for new approaches were presented at the American Society of Haematology’s (ASH) annual meeting and discussed by UK clinicians at a post-ASH meeting.

CAR-T cells have now been big news for some time and are getting closer to becoming available for people with lymphoma. The treatment harnesses the power of your immune system by modifying your own immune cells to recognise and kill lymphoma cells. CAR-T cells may be as effective as allogenic stem cell transplant for relapsed diffuse large B-cell lymphoma (DLBCL), and have fewer risks. However, the cells can’t be successfully produced for everyone. It is also becoming clearer that people who have a complete response to these treatments (no evidence of lymphoma) can have a long-lasting response. However, a partial response, where the lymphoma is reduced but not cleared completely, does not seem to last.

Newer drugs have been tested in diffuse large B-cell lymphoma for some time with little success, but antibody-drug conjugates are giving more promising results in clinical trials. These drugs join a strong chemotherapy drug with an antibody that targets the lymphoma cells. The antibody takes the drug directly to the lymphoma cells, reducing the effects of the drug on healthy cells. Antibody-drug conjugates currently being tested with promising initial results include polatuzumab vedotin and ADCT-402.

Practice-changing results from a clinical trial testing whether adding etoposide to CHOP chemotherapy (‘CHOEP’) for T-cell lymphoma showed that some people with anaplastic large cell lymphoma (ALCL) benefit greatly from the addition. People with a protein called ‘ALK’ on their ALCL cells (ALK positive ALCL) may now be treated with CHOEP if possible.

Finally, results from a review of cases of grey zone lymphoma showed only around a third of cases reviewed were actually grey zone lymphoma. The remaining cases were mis-diagnosed, with most being classical Hodgkin lymphoma. It is very important to get the correct diagnosis so you can have the most appropriate treatment.

Find out more about newer drugs for high-grade NHL or look for a clinical trials that might benefit you at Lymphoma TrialsLink.