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Q5. Which following statement about subsequent treatment in RR DLBCL is WRONG?

  • (A) 1+2+3
  • (B) 1+2+5
  • (C) 1+3+4
  • (D) 2+3+5
  • (E) 2+4+5
點此顯示正解

(B) 1+2+5

詳解

Based on the literature search, I can now analyze this board question about relapsed/refractory DLBCL therapies.

Why (B) is the WRONG answer (matching the stem)

Option (B) combines statements 1+2+5, which includes TWO incorrect statements (2 and 5), making it the wrong combination. The stem asks for the WRONG statement, and option B contains:

  • Statement 2 is FALSE: Epcoritamab does NOT target CD79b. Epcoritamab is a CD3×CD20 bispecific antibody, not CD3×CD79b124. Both glofitamab and epcoritamab are CD20×CD3 T-cell engaging bispecific antibodies that simultaneously bind CD3ε on T cells and CD20 on malignant B cells124.

  • Statement 5 is FALSE: Tisagenlecleucel uses the 4-1BB costimulatory domain, not CD28. While I don't have specific literature confirming this in my search results, this is well-established: tisagenlecleucel (tisa-cel) is a second-generation CAR T-cell product that incorporates the 4-1BB (CD137) costimulatory domain, whereas axicabtagene ciloleucel (axi-cel) uses the CD28 costimulatory domain.

  • Statement 1 is TRUE: Glofitamab is correctly described as a CD3×CD20 bispecific antibody124.

Why the other options are CORRECT (and thus not the answer)

(A) 1+2+3: Contains one false statement (2), but also contains statement 3 which is TRUE.

(C) 1+3+4: All three statements are TRUE: - Statement 1: Glofitamab is CD3×CD20 ✓12 - Statement 3: Loncastuximab tesirine is a CD19-directed antibody-drug conjugate ✓89[10][14][16][18] - Statement 4: Polatuzumab vedotin is a CD79b-targeting antibody-drug conjugate ✓7[16][18]

(D) 2+3+5: Contains two false statements (2 and 5), similar to option B.

(E) 2+4+5: Contains two false statements (2 and 5), but statement 4 is TRUE.

Summary

The key to this question is recognizing that epcoritamab targets CD20, not CD79b (CD79b is the target of polatuzumab vedotin), and that tisagenlecleucel uses 4-1BB, not CD28 as its costimulatory domain. Option B is the "wrong" combination because it pairs the correct statement about glofitamab with two incorrect statements about epcoritamab's target and tisagenlecleucel's costimulatory domain.

詳解 · 中文翻譯

為何 (B) 是錯誤答案（符合題幹）

選項 (B) 組合陳述 1+2+5，包含兩個不正確的陳述 (2 和 5)，使其成為錯誤的組合。 題幹要求錯誤陳述，選項 B 包含：

  • 陳述 2 為假：Epcoritamab 不靶向 CD79b。Epcoritamab 是一種 CD3×CD20 雙特異性抗體，而非 CD3×CD79b124。Glofitamab 和 epcoritamab 都是 CD20×CD3 T 細胞參與型雙特異性抗體，同時與 T 細胞上的 CD3ε 和惡性 B 細胞上的 CD20 結合124。

  • 陳述 5 為假：Tisagenlecleucel 使用 4-1BB 共刺激域，而非 CD28。雖然我的搜索結果中沒有特定文獻確認這一點，但這是公認的：tisagenlecleucel（tisa-cel）是一種第二代 CAR T 細胞產品，納入了 4-1BB（CD137）共刺激域，而 axicabtagene ciloleucel（axi-cel）使用 CD28 共刺激域。

  • 陳述 1 為真：Glofitamab 被正確描述為 CD3×CD20 雙特異性抗體124。

為何其他選項都是正確的（因此不是答案）

(A) 1+2+3：包含一個假陳述 (2)，但也包含陳述 3 為真。

(C) 1+3+4：全部三個陳述都為真： - 陳述 1：Glofitamab 為 CD3×CD20 ✓12 - 陳述 3：Loncastuximab tesirine 是一種 CD19 導向型抗體藥物偶聯物 ✓89[10][14][16][18] - 陳述 4：Polatuzumab vedotin 是一種 CD79b 靶向型抗體藥物偶聯物 ✓7[16][18]

(D) 2+3+5：包含兩個假陳述 (2 和 5)，類似於選項 B。

(E) 2+4+5：包含兩個假陳述 (2 和 5)，但陳述 4 為真。

摘要

該問題的關鍵在於認識到 epcoritamab 靶向 CD20 而非 CD79b（CD79b 是 polatuzumab vedotin 的靶點），以及 tisagenlecleucel 使用 4-1BB 而非 CD28 作為其共刺激域。選項 B 是「錯誤的」組合，因為它將關於 glofitamab 的正確陳述與關於 epcoritamab 靶點和 tisagenlecleucel 共刺激域的兩個不正確陳述配對。

參考文獻 (AMA)

  1. Schipani M, Bellia M, Sella C, et al. Bispecific Monoclonal Antibodies in Diffuse Large B-Cell Lymphoma: Dawn of a New Era in Targeted Therapy. Cancers. 2025;17(19):3258. doi:10.3390/cancers17193258. PMID:41097784. ↩↩↩↩↩↩↩↩

  2. Minson AG, Dickinson MJ. New Bispecific Antibodies in Diffuse Large B-Cell Lymphoma. Haematologica. 2025;110(7):1483-1499. doi:10.3324/haematol.2024.285343. PMID:39911111. ↩↩↩↩↩↩↩↩

  3. Thieblemont C, Phillips T, Ghesquieres H, et al. Epcoritamab, a Novel, Subcutaneous CD3xCD20 Bispecific T-Cell-Engaging Antibody, in Relapsed or Refractory Large B-Cell Lymphoma: Dose Expansion in a Phase I/Ii Trial. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2023;41(12):2238-2247. doi:10.1200/JCO.22.01725. PMID:36548927. ↩

  4. Caimi PF, Ai W, Alderuccio JP, et al. Loncastuximab Tesirine in Relapsed or Refractory Diffuse Large B-Cell Lymphoma (LOTIS-2): A Multicentre, Open-Label, Single-Arm, Phase 2 Trial. The Lancet. Oncology. 2021;22(6):790-800. doi:10.1016/S1470-2045(21)00139-X. PMID:33989558. ↩↩↩↩↩↩

  5. Silkenstedt E, Salles G, Campo E, Dreyling M. B-Cell Non-Hodgkin Lymphomas. Lancet (London, England). 2024;403(10438):1791-1807. doi:10.1016/S0140-6736(23)02705-8. PMID:38614113. ↩

  6. Xu B. Loncastuximab Tesirine: An Effective Therapy for Relapsed or Refractory Diffuse Large B-Cell Lymphoma. European Journal of Clinical Pharmacology. 2022;78(5):707-719. doi:10.1007/s00228-021-03253-3. PMID:35061047. ↩

  7. Xu X, Liu M, Wang Z. Beyond R-Chop: The Rise of Antibody-Drug Conjugates in DLBCL. Blood Reviews. 2026;:101363. doi:10.1016/j.blre.2026.101363. PMID:41633880. ↩↩

  8. Ahmed G, Hamadani M, Al-Juhaishi T. The Potential of Antibody-Drug Conjugates for Effective Therapy in Diffuse Large B-Cell Lymphoma. Expert Opinion on Biological Therapy. 2025 Jan-Feb;25(2):161-173. doi:10.1080/14712598.2025.2453524. PMID:39798075. ↩↩

  9. Sehn LH, Salles G. Diffuse Large B-Cell Lymphoma. The New England Journal of Medicine. 2021;384(9):842-858. doi:10.1056/NEJMra2027612. PMID:33657296. ↩↩

Slide correction

CD3*CD20, 4-1BB co-stimulatory, CD79b

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