Review of Current Therapies in Relapsed DLBCL and the L-MIND Trial


Christopher R. Flowers, MD, discusses current therapies used for patients with relapsed / refractory diffuse large B-cell lymphoma and goes into the details of the L-MIND trial after long-term follow-up.

Christopher R. Flowers, MD, department head of the Department of Lymphoma / Myeloma, Division of Cancer Medicine at the University of Texas MD Anderson Cancer Center, discusses current therapies used for patients with diffuse large B-cell lymphoma in relapse / refractory (DLBCL) and goes into the details of the L-MIND trial (NCT02399085) after long-term follow-up.

There are several therapies and combination therapy approved in this context, including chimeric antigen receptor (CAR) T cell therapy. The 2021 annual meeting of the American Society of Clinical Oncology (ASCO) provided some updates for the trials in this space, including the multicenter, open-label, single-arm, phase 2 L-MIND trial.


0:08 | What we have observed, however, is a dramatic change in the number of therapies available for relapse. It was with the advent of polatuzumab [Polivy] combined with bendamustine and rituximab [Rituxan], tafasitamab [Monjuvi] combined with lenalidomide [Revlimid], and now loncastuximab tesirine [Zynlonta] approved in this third-line space or later, and the advent of 3 different CAR T therapies that are now approved for relapse for LDGCB. Then selinexor [Xpovio] which is also approved in this space. So really a whole series of options. At this year’s ASCO meeting, we saw an update on some of these trials, and in particular the one on the combination of tafasitamab and lenalidomide, or the L-MIND trial.

What was the design and effectiveness of the L-MIND trial?

1:08 | When we look at the L-MIND trial, it is a trial that has been published with updated results in Lancet Oncology in 2020 describing a patient population of approximately 81 patients. When you look at the characteristics of the population, the median age at enrollment was around 72 years, which is relatively similar to what we would see for a general population of patients with LDGCB; 11% of these patients had already undergone a stem cell transplant. This is generally a population of older patients who have not had a transplant as part of their care. The majority of patients had a median of 2 previous treatment lines, so still relatively early in their treatment cycle. When looking at response rates, and especially when looking at response rates by number or past treatment lines, what was presented in the updated results at ASCO showed for patients who had 1 Prior line of therapy, that the complete response rate was 48% versus those who had had 2 or more lines of treatment, and the trial was roughly split half and half between these 2 different groups. Those who had had 2 or more previous lines of treatment had a 33% complete response rate. The duration of response appeared to be fairly durable for both groups, being greater than 44 months in both groups of respondents.

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