Liposomal Vincristine as a Bridge Therapy Prior to CAR-T Therapy in Relapsed and Refractory Diffuse Large B-Cell Lymphoma?

  • Juskaran Chadha Department of Hematology & Medical Oncology, Lenox Hill Hospital Northwell Health, New York, NY
  • Shafinaz Hussein Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA
  • Yougen Zhan Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA
  • Jonah Shulman Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA
  • Joshua Brody Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA
  • Lynn Ratner Department of Hematology & Medical Oncology, Lenox Hill Hospital Northwell Health, New York, NY
  • Amir Steinberg Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA
Keywords: CAR-T; Liposomal vincristine; DLBCL; Heavily pretreated; Autologous SCT

Abstract

We report a case of a 76-year-old male with a history of relapsed and refractory diffuse large B-cell lymphoma (DLBCL).Our patient was initially treated with front line chemotherapy along with central nervous system (CNS) prophylaxis with complete response. He subsequently relapsed, was sensitive to second-line chemotherapy, and underwent autologous stem cell transplantation achieving a complete remission. Only a few months after transplant, the patient suffered his second relapse and was deemed a candidate for Chimeric Antigen Receptor T-Cell Therapy (CAR-T). Given his aggressive disease, combined with the time needed to generate CAR-T cells, a multidisciplinary team recommended to treat our patient with liposomal vincristine in combination with rituximab as a bridge therapy. Durable responses have been seen using liposomal vincristine based on results from a recent phase II trial in heavily pretreated patients with DLBCL1. This therapy was effective in stabilizing and reducing active disease in our patient. This case looks to illustrate the use of liposomal vincristine in combination with immunotherapy in a novel setting bridging highly selected patients with active and refractory lymphoma prior to CAR-T. Moreover, we expanded an additional therapeutic point, highlighting the importance of optimal disease control prior to CAR-T cell harvesting, as recent literature has shown that residual malignant cells in the pheresis product may be inadvertently be transfected with the CAR gene, resulting in resistance and further relapse2.

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Published
2019-04-10
How to Cite
1.
Chadha J, Hussein S, Zhan Y, Shulman J, Brody J, Ratner L, Steinberg A. Liposomal Vincristine as a Bridge Therapy Prior to CAR-T Therapy in Relapsed and Refractory Diffuse Large B-Cell Lymphoma?. Int J Hematol Oncol Stem Cell Res. 13(2):102-107.
Section
Case Report(s)