Keywords
bispecific antibodies
relapsed/refractory lymphomas
How to Cite
Abstract
Diffuse large B cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma. When patients do not respond to the initial treatment (primary refractory) or relapse after first complete remission, if they are eligible for highdose chemotherapy, they are usually treated with a rescue immunochemotherapy regimen, followed by consolidation with autologous bone marrow transplantation, if they have responded to the second- line treatment. However, approximately half of transplanted patients relapse after transplantation. Treatment with a new line of immunochemotherapy in these refractory or relapsed patients before one year after transplantation shows disappointing results with median overall survival of only 6 months. In addition, patients with relapsed or refractory (R/R) DLBCL who are ineligible for transplant, until recently had very few therapeutic alternatives. In recent years, new strategies have emerged, such as the incorporation of polatuzumab vedotin to the rituximab and bendamustine regimen, bispecific antibodies (glofitamab, epcoritamab, mosenutuzumab and odronextamab), the combination of tafasitamab and lenalidomide, in addition to CAR-T therapy. Among these mentioned alternatives, epcoritamab has recently been approved by the ANMAT for patients with DLBCL R/R to at least two therapeutic lines. The present work reviews its mechanism of action, the results of the pivotal EPCORE NHL 1 trial, as well as the recommendations for its administration, with special emphasis on the suggested premedication, and the treatment of cytokine release síndrome and neurotoxicity syndrome associated with immunoeffector cells. Dose adjustments in special populations and recommendations on patients' vaccination are also reviewed.
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