BloodCancerTalks: ASH 2025 Lymphoma Roundup

Guest: Dr. Carla Casulo, Associate Professor, Wilmot Cancer Centre, University of Rochester

Abstracts Discussed

Follicular Lymphoma

EPCORE-FL1 (Falchi) - Epcoritamab plus lenalidomide-rituximab (R2) in relapsed/refractory FL

Theme: Bispecific antibody combinations in R/R FL; comparing to other approaches

Diffuse Large B-Cell Lymphoma (DLBCL) - Elderly/Unfit Patients

MorningSun (Sharman) - Mosunetuzumab monotherapy in patients ≥80 years or chemo-ineligible

EPCOR-DLBCL-3 (Vitolo) - Epcoritamab monotherapy in elderly patients

R-Pola-Glo - Rituximab-polatuzumab-glofitamab combination in older/frail patients

Theme: Single-agent and combination bispecific strategies for elderly and frail DLBCL patients

DLBCL - First-Line Treatment

SMART STOP (Westin) - Chemotherapy-free approach using lenalidomide, tafasitamab, rituximab, acalabrutinib (ULTRA regimen)

FrontMIND - Tafasitamab-lenalidomide added to R-CHOP

Theme: Chemotherapy-sparing and chemo-intensification strategies in newly diagnosed DLBCL

DLBCL - Relapsed/Refractory

DALY 2-EU (Borchmann) - Dual CD19/CD20 CAR-T (zamto-cel) versus R-GemOx in transplant-ineligible patients

Theme: Expanding CAR-T eligibility; treatment selection in transplant-ineligible R/R DLBCL

Hodgkin Lymphoma

SWOG 1826 - 3-year update: Nivolumab-AVD versus brentuximab-AVD

HD21 - 5-year update: PET-adapted BrECADD versus BEACOPP

Theme: Long-term outcomes and treatment selection in newly diagnosed Hodgkin lymphoma

Burkitt Lymphoma

ZUMA-25 (Van Dorp) - Brexucabtagene autoleucel (Brexu-cel) in relapsed/refractory Burkitt

Theme: CAR-T therapy for the challenging population of R/R Burkitt lymphoma

Mantle Cell Lymphoma - First-Line

TrAVeRse - Acalabrutinib, venetoclax, rituximab

GLOVe - Glofitamab, lenalidomide, venetoclax (high-risk MCL)

BOVen - Zanubrutinib, obinutuzumab, venetoclax (older patients)

MAVO - Acalabrutinib, venetoclax, obinutuzumab

Window-3 - Acalabrutinib-rituximab followed by brexu-cel (high-risk MCL)

Theme: Chemotherapy-free combinations in newly diagnosed mantle cell lymphoma

Join hosts Raj, Ashwin, and Eddie in this episode of Blood Cancer Talks as they welcome Dr. Luciano Costa, the first author of the NEJM manuscript on the MajesTEC-3 RCT, which was presented at ASH 2025. This episode dives deep into the trial's topline findings, capturing the nuances of the patient population, efficacy and safety data, and the future implications for treatment. The episode also examines the comparative efficacy of bispecific T-cell engagers versus CAR-T therapies, along with spirited discussion on the potential for fixed-duration treatment in myeloma care.

Episode Highlights

Main Topics Covered

1. MajesTEC-3 Trial: Teclistamab-Daratumumab vs. Standard of Care
   • Trial design and patient population
   • Primary endpoint: Progression-free survival (PFS)
   • MRD negativity rates and depth of response
   • Overall survival and safety profile
   • Clinical implications for treatment selection
2. Treatment Selection in Early Relapse
   • Comparing MajesTEC-3 and CARTITUDE-4 patient populations
   • Framework for choosing between bispecific antibodies vs. CAR T-cell therapy
   • Managing anti-CD38 exposed patients

Link to the NEJM paper: https://www.nejm.org/doi/abs/10.1056/NEJMoa2514663

Join hosts Eddie, Ashwin, and Raj as they welcome Dr. Michelle Yong and Dr. Gemma Reynolds, academic infectious diseases physicians from the Peter MacCallum Cancer Centre and the National Centre for Infections in Cancer, for an in-depth discussion on cytomegalovirus (CMV) management in immunocompromised hematology patients.

Key Topics Covered

Fundamentals of CMV Management

• Distinguishing CMV reactivation from CMV disease
• Treatment thresholds and target viral loads
• Prophylaxis strategies in non-allograft settings
• Valaciclovir dosing in general hematology populations
• High-risk patient populations

First-Line Therapies

• Valganciclovir: advantages, disadvantages, and myelosuppression
• Foscarnet: indications and monitoring strategies
• Treatment-resistant CMV

Allogeneic Transplant Patients

• High-risk populations and timing of reactivation
• Monitoring protocols post-transplant

Randomized Controlled Trials

AURORA Trial: Maribavir vs. Valganciclovir

• Design: RCT comparing maribavir to valganciclovir for pre-emptive CMV therapy post-allogeneic transplant [https://pubmed.ncbi.nlm.nih.gov/38036487/]

NEJM Letermovir Prophylaxis Trial

• Design: Double-blind, placebo-controlled RCT of letermovir prophylaxis post-allogeneic transplant [https://pubmed.ncbi.nlm.nih.gov/29211658/]

Emerging Patient Populations

• CMV in lymphoma and myeloma patients receiving CAR T-cell therapy and T-cell engaging bispecific antibodies
• Monitoring and prophylaxis strategies for novel immunotherapies
• Impact of CMV on post-CAR T mortality-https://pubmed.ncbi.nlm.nih.gov/40203190/