So for relapse ofracctory T cell lymphoma, um, You know, we, we think about two approaches. The, the one thing we have that could cure people in the relapse setting is allo transplant, and allot transplant is best, uh, the most successful when people are in complete response, and the best results for aloe based on subtype are for people with follicular helper angiomenoblastic T cell lymphoma. Yeah, as you know, there's a group of patients who are not gonna get an allo transplant. It's too toxic, it's too risky. They have, um, organ dysfunction or age or other things, um, uh, that would make aloe either unavailable or unattractive to them. And in those patients, we keep them well by controlling disease long term. So often in the relapse setting, we make a decision, are we treating aggressively with curative intent or are we treating in a maintenance fashion? And, and that really informs our strategy. Uh, I strongly support having patients have an early aoe consult to help them get their mind around it cause a lot of times the decision to move towards aloe or not is patient driven, you know, they hear about what that involves, and I'll sometimes say to patients, I'm gonna have you meet the aloe transplant team and you're gonna come back potentially with one or two options, you're gonna say to me, if that can cure me, I want that, and then we're gonna move in that direction, or I only want to do that if there's no other options, and, and there are other options. Um, so we kind of think about that a little bit binary in terms of what our, our strategy is. When we're thinking about bridging quickly to aloe, we think about, um, uh, therapies that have quick CRs, and we did have very quick CRs with um Duvaliib and Romodapsin. Most of the CRs were within cycle one, and a lot of patients were able to bridge to aoe after cycle two. Uh, so the advantage of that is you get an early CR We can give the allo team a month or so heads up to get things together, and then, um, while disease is under good control, uh, you can move patients to aloe, hopefully with curative intent. When we move patients from these regimens, which aren't really chemotherapy, we can also run the therapy pretty close to the transplant. So often we'll stop the therapy 10 days, 2 weeks or less, uh, before the aloe transplant because do list if you can stay on, uh, the Romodepsin, uh, you can stay on, um, uh, they're not that myelosuppressive, and then run up to the aloe, so we don't give the lymphoma uh very much of a, of a break. Romoepsin does add though a lot of um uh uh or adds I should say, add some toxicity. So it's a 4 hour weekly infusion, so that takes a toll on people. It has more things like uh fatigue, um nausea, dysphsia. Patients don't feel well on it. So if our goal is really long term maintenance, it's easier from a quality of like day to day standpoint to be on a single agent like Duvali. So often in those cases, if we're using Duvali, we might start with Duilism as a single agent. I like the 75 dropping to 25 uh regimen because it made sense based on the data we saw and it's where we have the most data, um. Um, so we'll usually use that regimen and then try to maintain them long term on the list and use that, uh, as a single agent maintenance, both for better day to day quality of life, um, uh, um, and as something that really could control these long term, particularly the follicular helper T cell lymphoma patients. If the response is not adequate, we can always add another agent, we could add Roadapsin, we can go to a different strategy, but that's kind of um how we think about that or how, how, how we tend to practice off study. We do have other studies, uh, and other combinations we're looking at, so there's ECH inhibitors, uh, in clinical trials that preliminary look look quite good in T cell lymphomas. Um, my colleague Alison Moskowitz has led another uh follow on study of Dubiliid plus roxalitinib, uh, which early on does look like it has some, uh, uh, high response rates in follicular helper T cell lymphomas and some other subtypes of T cell lymphoma interesting like PLL and she presented that data to Ash last year and and that study is being expanded. Early on, it looks like roxitin may do some of the same or have some of the same protective effects as Romodopsin. Uh, in terms of reducing some of the inflammatory side effects, uh, that's not worked out, uh, to the same degree, but if it did, uh, that would be a nice option because that's an oral agent with a, a, a more favorable side effect profile and if it did the same protective effect, um, that would probably be something easier for patients, uh, on long-term maintenance than uh than adding the Romodepsin.
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