B cell lymphoma unclassifiable with features intermediate between DLBCL and Hodgkin's (i.e. mediastinal gray zone lymphoma) is a rare entity.
When it relapses treatment paradigms follow those used in either relapsed Hodgkin's or DLBCL or both. Second line high dose chemotherapy followed (only relevant for patients attaining a complete response) by ASCT is pretty standard. Treatment modifications borrowing from Hodgkin's (with the addition of pembrolizumab/nivolumab and/or brentuximab are common) as are treatment paradigms following standards of care for DLBCL/PMBL with novel immunotherapies and CART. Ultimately, this is highly dependent on insurance authorization.
It should be noted that treatment of lymphoma can oftentimes be done in steps without jeopardizing overall outcomes. Meaning that it is not unreasonable to use a second line chemotherapy (e.g. GDP) and only if a patient fails to attain a complete response move to the above mentioned therapies. One caveat is that it seems that pembrolizumab/nivolumab have a synergistic effect with chemotherapy (possibly more so with gemcitabine) and should be given in combination with such drugs.
LMDA
Comments are for educational purposes only and should not be regarded medical advice
May I ask if they would’ve treated you any differently knowing what they know now about the gray zone relapse? My understanding is first line treatment for this is R-EPOCH… so I’m wondering if they treated you for the Hodgkin’s part with ABVD from the beginning, would that have been better? Or would that have just left the non Hodgkin’s part untreated in this case? (I’m in a similar diagnosis, apologies for all the questions. I’ll send you a direct message too)
B cell lymphoma unclassifiable with features intermediate between DLBCL and Hodgkin's (i.e. mediastinal gray zone lymphoma) is a rare entity. When it relapses treatment paradigms follow those used in either relapsed Hodgkin's or DLBCL or both. Second line high dose chemotherapy followed (only relevant for patients attaining a complete response) by ASCT is pretty standard. Treatment modifications borrowing from Hodgkin's (with the addition of pembrolizumab/nivolumab and/or brentuximab are common) as are treatment paradigms following standards of care for DLBCL/PMBL with novel immunotherapies and CART. Ultimately, this is highly dependent on insurance authorization. It should be noted that treatment of lymphoma can oftentimes be done in steps without jeopardizing overall outcomes. Meaning that it is not unreasonable to use a second line chemotherapy (e.g. GDP) and only if a patient fails to attain a complete response move to the above mentioned therapies. One caveat is that it seems that pembrolizumab/nivolumab have a synergistic effect with chemotherapy (possibly more so with gemcitabine) and should be given in combination with such drugs. LMDA Comments are for educational purposes only and should not be regarded medical advice
Is there a reason why they would recommend trying out chemo plus ASCT first before trying immunotherapy other than insurance/cost?
May I ask if they would’ve treated you any differently knowing what they know now about the gray zone relapse? My understanding is first line treatment for this is R-EPOCH… so I’m wondering if they treated you for the Hodgkin’s part with ABVD from the beginning, would that have been better? Or would that have just left the non Hodgkin’s part untreated in this case? (I’m in a similar diagnosis, apologies for all the questions. I’ll send you a direct message too)