CHOP

And then, you know, I found its way to my brain and then it went from there and As I've said, it comes down to the individual and the situation they're in.

You might be going down the same treatment, the same R-CHOP and the chemo and all that fun stuff that we go through, but there's always a difference in the support you have.

Some people, poor buggers out there, they don't have that support like I had.

They don't have the wife who will drop everything and just go right over your number one priority.

I went through exactly the same deal with my parents.

First time around, they come up and visited, gave me the support, helped around the house, did what they had to do.

But then it got to a certain point It's my first round of R-CHOP treatment and chemo and all that when that started.

And this is going back 2024 now.

The patients where often we kind of have, um, a, a little more discussion are the limited stage patients.

So limited stage without extranodal involvement, um, double hit lymphoma, there is data that has demonstrated that R-CHOP has, um, kind of similar efficacy, both in terms of attaining a CR rate as well as, um, kind of late relapse.

And, um, I, I think in that situation, I feel more comfortable n-not utilizing dose-adjusted R-EPOCH.

Mm-hmm.

They have tumor lysis syndrome, they look terrible, their performance status is declining due to the disease, um, it's rapidly proliferative.

And so I think it's extraordinarily difficult in a prospective clinical trial that you have to enroll a patient and look for eligibility criteria to, um, in, in a non-biased way randomize between dosages to R-EPOCH and other regimens.

And, and so I think that's the main criticism, you know, of the randomized trial between EPOCH and R-CHOP, is like those patients had to wait several days before starting therapy, and most double-hit patients who are very sick, you don't have that luxury.

Yes, that is right.

I was in the hospital for 15 days, bedridden for about seven days.

Two days before I left, the doctor, medical director came to me and she's like, you need to start something called RCHOP chemotherapy.

Now, mind you, most people, when they're told they have cancer, they have time to breathe and trying to figure it out, see what next steps.

I was bedridden in the hospital for Being told all this, this was back in 2014.

So I did the RCHOP chemotherapy.

I did one round in the hospital, five other rounds every three weeks.

And in 2014, about five days before Christmas, I got my remission status and I was in remission for a decade until June of 2024. when I had a relapse and that led to a pretty involved, comprehensive healthcare journey, which includes a stem cell transplant.

We'll highlight some of the therapies currently under development.

Looking at the NCCN guidelines for preferred regimens in relapsed refractory B-cell lymphoma, specifically looking at those for follicular lymphoma, we see second-line options not in preferred order, including chemoimmunotherapy, which includes the option of bendamustine, CHOP or CVP, plus or minus a CD20 antibody, more specifically rituximab or bentuzumab.

Additionally, other options include continued use of an obinutuzumab in this patient population.

What you see here is really a list of agents with activity in relapsed T-cell lymphoma.

They interviewed...

When we think about survivors, I think you think about short-term treatment, obviously, for example, diffuse large B-cell, R-CHOP, Hodgkin lymphoma as well, short-term treatment followed by cure in a lot of patients, and then long-term issues.

And the second paper, I think, um, um, interviewed a bunch of survivors themselves as well as, well as providers, and came up with three important themes.

One, of course, the anxiety that people have about the potential recurrence.

So I thought I'd just kinda get your brief thoughts, uh, on what your survivorship programs look like.

We are the kind of people, the kind of services, uh, provided.

And any issues, you know, we have-- it's almost July first, time for the new fellows when they come in July first, and they see a patient who's getting followed up for, uh, who's got R-CHOP and is NED now.

Uh, I'm curious how your centers, uh, deal with these people and what kind of clinics you have.

It has modest activity in patients with relapsed large cell lymphoma, but there's a subset of patients that can do very well with it.

Here we were adding that Tafalen program on top of R-CHOP compared to R-CHOP alone.

And these data were first reported out here at ASCO 2026.

And what you see is the hazard ratio here is quite similar to the hazard ratio from polituzumab substitution with the hazard ratio of 0.75, so 25% lower risk of progression or death by adding taffylin on top of R-CHOP as compared to R-CHOP alone.

And that translated to two- and three-year PFS quantitative benefits, as you see, you know, two-year benefit of about 8% and about 7% of the three-year mark.

Overall survival, as we saw with Polarix, was not improved by the addition of these two extra drugs.

And so then it moved forward, and as is typical, we started giving it with chemoimmunotherapy.

And so there's two data sets in the frontline setting, one with R-CHOP, one with R-CHP plus polatuzumab, and both of those data sets indicate high CR rates, well over ninety percent for both compounds.

The two-year PFS rate with R-CHOP was right around eighty percent, and among those patients that did have CT data-based MRD assays, the MRD negativity rates were quite high in that context as well.

We saw similar findings in the R-CHP pola data sets.

They don't have the two-year PFS.

I, I think you, you hit on a really key- Kind of topic or key, key point here.

We're, we are patients, and as, as providers, we're really fortunate to have this, this kind of increasing armamentarium of drugs that we can use for the treatment of lymphoma that's really effective.

But what we run into now, which is for decades in large cell lymphoma, we, we didn't have a regimen that could beat R-CHOP, for example, right? So now, now we're starting to see stu- Phase 3 studies that are randomized that are showing that you can achieve better durable disease control with other regimens compared to R-CHOP.