Treatment Patterns and Real-World Outcomes in Patients with Relapsed or Refractory LBCL in the 2L Setting

Patients with large B-cell lymphoma (LBCL) who fail first-line (1L) treatment may be candidates for high-dose chemotherapy (HDCT) followed by hematopoietic stem-cell transplantation (SCT) if they respond to salvage chemotherapy; however, patients unable to undergo HDCT followed by SCT have limited treatment options often accompanied by poor outcomes. Aiming to characterize the demographics, clinical characteristics, treatment patterns, and outcomes in patients with LBCL receiving second-line (2L) therapy with or without HDCT followed by SCT in the real-world setting, findings from a retrospective, observational study were reported at the 2022 European Hematology Association Congress.

Using electronic health record data from the Flatiron Health database from January 1, 2011, to September 30, 2021, a retrospective observational study was performed in adult patients with relapsed or refractory LBCL in the United States. Index date was defined as the 2L therapy initiation date, and patients were followed from index date until the end of study or death. Eligibility criteria included a diagnosis of LBCL, 1L treatment with an anti-CD20 therapy and anthracycline, 2L therapy with or without HDCT followed by SCT, and ≥12 months (mo) of follow-up. Patient demographics, clinical characteristics, treatment patterns, and overall survival (OS) were examined. Survival probabilities were estimated by Kaplan-Meier log-rank analysis. Risk of death between groups was assessed by Cox proportional hazards regression models.

Of 881 patients who met the eligibility criteria, 142 (16.1%) received HDCT followed by SCT and 739 (83.9%) did not. Median follow-up time was 17.3 mo. Of all patients, median age was 67 years (range, 19-85), 58.6% were male, 61.9% had stage III or IV disease, and 84.7% received treatment in a community setting. Baseline characteristics were similar among patients receiving HDCT followed by SCT and those not. Among patients receiving HDCT followed by SCT, the most common 2L treatments were rituximab plus ifosfamide, carboplatin, and etoposide (R-ICE) (72.5%) and rituximab plus gemcitabine, dexamethasone, and cisplatin (6.3%); the most common third-line (3L) treatments were bendamustine plus rituximab (BR; 12.2%) and lenalidomide plus rituximab (12.2%). Among patients who did not receive HDCT followed by SCT, the most common 2L treatments were R-ICE (25.3%) and BR (12.2%); the most common 3L treatments were rituximab plus gemcitabine and oxaliplatin (11.9%) and R-ICE (8.2%). Patients may have been intended to proceed to HDCT followed by SCT but did not due to lack of treatment response. Median (95% confidence interval [CI]) OS was 22.1 mo (17.9-29.0), 100.0 mo (71.3-not reached [NR]), and 15.4 mo (12.9-19.7) in all patients, patients receiving HDCT followed by SCT, and patients not receiving HDCT followed by SCT, respectively (P <.0001); OS probabilities at 12 mo (24 mo) were 60.2% (48.4%), 85.9% (77.3%), and 55.2% (42.8%), respectively. Of 881 patients, 645 (73.2%) and 236 (26.8%) relapsed ≤12 mo and >12 mo from initiation of 1L therapy, respectively. Median (95% CI) OS was 14.3 mo (12.1-18.7) and 47.8 mo (35.8-NR) in patients who relapsed ≤12 mo versus >12 mo from start of 1L therapy (P <.0001); OS probabilities at 12 mo (24 mo) were 54.0% (42.4%) and 77.1% (64.9%), respectively. The risk of death was significantly greater among patients who relapsed ≤12 mo versus >12 mo from 1L therapy (hazard ratio, 1.81; 95% CI, 1.45-2.26; P <.0001).

In conclusion, patients with LBCL who did not receive HDCT followed by SCT in the 2L or who relapsed within ≤12 mo of 1L therapy initiation have poor prognoses. Significant unmet needs exist in patients unable to derive benefits from transplant conditioning followed by SCT.

Source

Lunning M, Che M, Gu T, et al. Treatment patterns and real-world outcomes in patients with large B-cell lymphoma who received second-line therapy. Presented at: 2022 European Hematology Association Congress, June 9-17, 2022; Vienna, AT. Abstract 1204.

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