The Role of Radiation in Diffuse Large B-Cell Lymphoma in 2021

Topline  Presentation Points

Evolution of radiation (RT) in diffuse large B-cell lymphoma (DLBCL) 

An Evolving Question 

• Does radiotherapy provide benefit to patients with DLBCL? 
• What is the incremental benefit of RT to patients with DLBCL with immunochemotherapy?  
• What is the incremental benefit of RT to patients with DLBCL with complete metabolic response? 

State of the Evidence 

• Most trials designed to address duration of chemotherapy, rather than benefit of RT 
  • Many trials not based on modern treatment practice 
  • Lack of chemoimmununotherapy 
  • Lack of functional imaging 
  • Old RT doses and techniques 
  • Incomplete local control data 

• Heterogenous patient population 
  • What is the incremental benefit of RT in the era of chemo-immunotherapy?

Clinical Considerations 

• • • Bulky Disease  
      • In Elderly Patients 
      • In Young Patients 

• • • Bony Disease 
    • Primary Mediastinal B-Cell 
      Lymphoma 

• • • Can PET guide our decision on when to use combined modality treatment?
      • PET in Early-Stage Disease LYSA/GOELAMS 02-03 Trial (France)
        (Lamy et al:Blood. 2018 Jan 11; 131(2): 155–156) 

• • • • PET-Directed RT: Elderly Patients with Bulk
        
        OPTIMAL>60 
        (Pfreundschuh M, et al. J Clin Oncol 2017; 35 (15_suppl): 7506.)

• • • Applying these trials to practice 

           New Frontiers: Relapsed and Refractory 

• • • • Bridging Radiotherapy with CAR T 
        • Disease stabilization and symptom control 
        • Decrease CAR T-cell toxicity 
        • Improve local control, and outcomes from CAR T