Rituximab/Bendamustine or Rituximab/Ifosfamide/Carboplatin/Etoposide as Second-Line Therapy for Relapsed/Refractory Diffuse Large B-Cell Lymphoma: A Real-World Analysis

Abstract

Rituximab/bendamustine (RB) and rituximab/ifosfamide/carboplatin/etoposide (R-ICE) are commonly used to treat relapsed/refractory diffuse large B-cell lymphoma (DLBCL), although their effectiveness has not been compared in real-world practice. This study evaluated data from DLBCL patients who relapsed after or were refractory to first-line therapy in an electronic health record (EHR)-derived database between 2011 and 2018. One hundred thirty-seven patients using RB and 270 patients using R-ICE were included for analysis. Transplantation after second-line therapy was considered a censored event in the time-to-event analyses. Patients in the RB group were older and had poorer performance status while there were no significant differences in stage, cell of origin, and double-/triple-hit subtypes. Relative to the R-ICE group, the RB group had significantly longer time-to-next-treatment (TTNT) and overall survival (OS). Subgroup analyses revealed that patients who were <70 years or had better performance status consistently had better TTNT and OS if they had received RB. Patients who had disease progression within 12 months after induction chemotherapy had a significantly inferior prognosis, regardless of the salvage treatments. Multivariable analysis revealed that RB treatment independently predicted better TTNT and OS. These data indicate that RB may be an alternative to R-ICE as second-line therapy for selected DLBCL patients.