1. Tafasitamab - CD 19 Ab: approved with lenalidomide for patients with R/R DLBCL ineligible for ASCT. median OS 3 yr. 2L, ineligible for ASCT. CR 43%, ORR 60%, 1 yr OS 74%. L-MIND study.
2. Loncasituximab- ADC against CD19: with revlimid or ibritunib with 50% ORR. 3L. LOTIS -2 trial. PFS 10 months. Neutropenia, tpenia, and increased GGT.
3. Polatuzumab- ADC against CD79b- 3rd line for R/R. in combo with BR. Can be 2nd line if not ASCT candidate or CAR-T candidate.
4. Selinexor- XPO1 inhibitor- approved 3L. SADAL study. Cytopenias, fever, fatigue. ORR 28%. median PFS 9 m.
Other agents:
1. Pembrolizumab - approved for R/R primary mediastinal B-cell lymphoma (PMBL) based on the results of KEYNOTE-170 which demonstrated an ORR of 41.5% (CR 20.8%), with median PFS and OS of 4.3 and 22.3 months
2 Brentuximab +/- Rituxan in CD 30+ DLBCL . Works even without CD 30 positivity.
2025 update: BV 1.2 mg/kg q 3 weeks+ rituxan q 3 weeks+ Lenalidomide 20 mg daily- 3rd line versus R2 as the comparator. Median OS 13.8 m versus 8.5 months. ( JCO March 2025) ECHELON-3. The PFS was low. Therefore may be a bridging therapy to ASCT or CAR-T. This regimen worked even in those who relapsed after CAR-T and high IPI.
3. Revlimid and other CELMods: single agents with < 30% ORR.
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