Real-World Practice Patterns and Outcomes in Veterans with Relapsed/Refractory Diffuse Large B-Cell Lymphoma

Abstract

Aim: To describe practices and outcomes in veterans with relapsed/refractory diffuse large B-cell lymphoma. Patients & methods: Using Veteran Affairs Cancer Registry System and electronic health record data, we identified relapsed/refractory diffuse large B-cell lymphoma patients completing second-line treatment (2L) in 2000–2016. Treatments were classified as aggressive/nonaggressive. Analyses included descriptive statistics and the Kaplan–Meier estimation of progression-free survival and overall survival. Results: Two hundred and seventy patients received 2L. During median 9.7-month follow-up starting from 2L, 470 regimens were observed, averaging 2.7 regimens/patient: 219 aggressive, 251 nonaggressive. One hundred and twenty-one patients proceeded to third-line, 50 to fourth-line and 18 to fifth-line treatment. Median progression-free survival in 2L was 5.2 months. Median overall survival was 9.5 months. Forty-four patients (16.3%) proceeded to bone marrow transplant. Conclusion: More effective, less toxic treatments are needed and should be initiated earlier in treatment trajectory.

Real‐world patient characteristics, treatment patterns, and treatment outcomes of patients with diffuse large B‐cell lymphoma by line of therapy

“…In our study, 17.4% ( N = 59/340) of 2L patients received autologous SCT with various salvage regimens, 13.5% ( N = 46/340) received R‐ICE, and 10.3% ( N = 35/340) received BR. These estimates are consistent with evidence reported in previous studies 7,15,16 . These treatment patterns highlighted notably lower uptake of therapies in later lines of treatment, including CAR‐T (9.9% in 3L and 11.8% in 4L).…”

“…5 These and other studies demonstrated that patients with R/R DLBCL experience suboptimal outcomes across later LOTs, highlighting the persistent need for additional, effective treatment options. 7,16 Accordingly, NCCN guidelines recommend clinical trials in instances where CAR-T therapy is inaccessible or not indicated for treatment in later LOTs. 23 One strength of our study is that we used the COTA oncology database with granular demographic and clinical information.…”

Glofitamab as a salvage treatment for B‐cell lymphomas in the real world: A multicenter study in Taiwan

“…4,5 Despite these efforts, durable remission remains elusive for many, which results in disease relapse. [6][7][8] The limited treatment options for relapsed/refractory (r/r) DLBCL underscore an unmet clinical need, which urges the development of new therapies for this patient population. 6,9 Recent studies have shown the promise of managing r/r DLBCL with several novel therapies, including CD19-targeted chimeric antigen receptor (CAR)-T cell therapy and antibody-drug conjugates (ADCs).…”

“…However, some patients are unable to achieve deep and lasting remission, which necessitates the application of second‐line salvage therapy and autologous hematopoietic stem cell transplant (auto‐HSCT) 4,5 . Despite these efforts, durable remission remains elusive for many, which results in disease relapse 6–8 . The limited treatment options for relapsed/refractory (r/r) DLBCL underscore an unmet clinical need, which urges the development of new therapies for this patient population 6,9 …”

Burden of Illness and Treatment Patterns in Second-line Large B-cell Lymphoma

“…Prior real-world studies of the treatment of relapsed or refractory LBCL are focused on DLBCL and out-ofdate, 15 focused on a limited population (eg, Medicare patients or veterans), [16][17][18] or confounded by inclusion of data from patients cured by first-line therapy. [19][20][21] In addition, data are limited on real-world treatmentrelated adverse events during second-line therapy that occur outside hospitalization for SCT.…”