From the Guidelines
Anaplastic large cell lymphoma (ALCL) should be treated with brentuximab vedotin 1 CHP as a preferred first-line therapy option, based on the results of the ECHELON-2 trial and FDA approval 1. This approach is supported by the NCCN guidelines, which recommend brentuximab vedotin as a category 1 option for patients with ALCL, and category 2A for other CD30-positive histologies. The treatment of ALCL depends on the ALK status and disease stage, with CHOP or CHOEP being the standard first-line treatment for most patients. However, for ALK-positive ALCL, CHOP alone may be sufficient, while for ALK-negative ALCL, more intensive regimens like CHOEP or dose-adjusted EPOCH may be used. In cases of relapsed or refractory disease, brentuximab vedotin is highly effective, and autologous stem cell transplantation may be recommended as consolidation therapy. Some key points to consider in the treatment of ALCL include:
- The importance of prompt treatment initiation after diagnosis
- Careful monitoring for treatment-related toxicities, including neutropenia, neuropathy, and cardiac effects
- The potential use of radiation therapy for bulky disease or residual masses after chemotherapy
- The consideration of clinical trials for patients with other subtypes of PTCL, such as PTCL-NOS, AITL, EATL, MEITL, nodal PTCL, TFH, and follicular T-cell lymphoma. As noted in the ESMO clinical practice guidelines, brentuximab vedotin monotherapy is evidence-supported and recommended for relapsed/refractory ALCL, with an overall response rate of 86% and a complete response rate of 57% 1.
From the FDA Drug Label
1.8 Relapsed or Refractory Large B-Cell Lymphoma (LBCL) ADCETRIS in combination with lenalidomide and a rituximab product is indicated for the treatment of adult patients with relapsed or refractory LBCL, including diffuse large B-cell lymphoma (DLBCL) NOS, DLBCL arising from indolent lymphoma, or high-grade B-cell lymphoma (HGBL), after two or more lines of systemic therapy who are not eligible for auto-HSCT or chimeric antigen receptor (CAR) T-cell therapy.
Anaplastic large B-cell lymphoma treatment is addressed in the context of relapsed or refractory Large B-Cell Lymphoma (LBCL). The treatment involves brentuximab vedotin (IV) in combination with lenalidomide and a rituximab product for adult patients after two or more lines of systemic therapy who are not eligible for auto-HSCT or CAR T-cell therapy 2.
From the Research
Treatment Options for Anaplastic Large B-Cell Lymphoma
- Traditional chemotherapy regimens, such as cyclophosphamide, vincristine, doxorubicin, and prednisone (CHOP), have been recommended for first-line treatment 3, 4, 5
- Dose-intensive chemotherapy and hematopoietic stem cell transplantation have been studied to improve patient survival 3
- Targeted drugs and immunotherapies, including anaplastic lymphoma kinase inhibitors, brentuximab vedotin, mTOR inhibitors, programmed cell death protein 1/programmed death ligand 1 inhibitors, and chimeric antigen receptor-T cell therapy, have emerged as new treatment options 3, 4, 6
- Brentuximab vedotin, an anti-CD30 antibody-drug conjugate, has shown substantial activity in the relapsed/refractory setting and is being studied in the front-line setting 4, 6
Specific Treatment Regimens
- CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy followed by involved field radiotherapy has been used to treat primary anaplastic large cell lymphoma of the lung 5
- VNCOP-B (etoposide, mitoxantrone, cyclophosphamide, vincristine, prednisolone, and bleomycin) regimen has been used to treat recurrence of primary cutaneous anaplastic large-cell lymphoma in elderly patients 7