Polatuzumab-based regimen or CAR T cell for patients with refractory/relapsed DLBCL—a matched cohort analysis

• Published in: Annals of hematology Vol. 101; no. 4; pp. 755 - 762
• Main Authors: Avivi, Irit, Perry, Chava, Segman, Yafit, Amit, Odelia, Bar-On, Yaeli, Katz, Ofrat Beyer, Gold, Ronit, Ribakovsky, Elena, Avigdor, Abraham, Vainstein, Vladimir, Goldschmidt, Neta, Ringelstein-Harlev, Shimrit, Horowitz, Netanel A., Gutwein, Odit, Gurion, Ronit, Itchaki, Gilad, Abadi, Uri, Nemets, Anatoly, Sofer, Orit, Vezker, Miri, Tadmor, Tamar, Dally, Najib, Filanovsky, Kalman, Leiba, Merav, Sarid, Nadav, Benyamini, Noam, Luttwak, Efrat, Herishanu, Yair, Ram, Ron
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.04.2022; Springer Nature B.V
• Subjects: Antibodies, Monoclonal - therapeutic use; Antigens; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Chemotherapy; Cohort analysis; Cohort Studies; Dehydrogenases; Drug dosages; Hematology; Humans; Immunoconjugates - therapeutic use; Immunotherapy; Lymphocytes; Lymphoma; Lymphoma, Large B-Cell, Diffuse - chemically induced; Lymphoma, Large B-Cell, Diffuse - drug therapy; Medicine; Medicine & Public Health; Monoclonal antibodies; Oncology; Original Article; Patients; Receptors, Chimeric Antigen; Retrospective Studies; T-Lymphocytes; Targeted cancer therapy; Relapsed/refractory DLBCL; CAR T
• ISSN: 0939-5555; 1432-0584; 1432-0584
• DOI: 10.1007/s00277-021-04749-9

Polatuzumab (Pola)-based regimens and chimeric antigen receptor T (CAR T) cells provide superior outcome compared to conventional chemoimmunotherapy in patients with relapsed/refractory diffuse large B cell lymphoma (R/R DLBCL). Choosing between these strategies remains controversial. The efficacy of CAR T versus Pola-rituximab(R) /Pola-bendamustine(B)-R in R/R DLBCL patients after failing ≥2 lines of treatment was compared in a retrospective, ‘real-world’ study. Propensity score matching, for age, lymphoma category (de-novo/transformed), number of prior lines, Eastern Cooperative Oncology Group performance status and lactate dehydrogenase level, was applied to control for differences in patients’ characteristics. Response rate, progression-free survival (PFS) and overall survival (OS) were analyzed. A total of 82 patients, treated with CAR T ( n =41) or Pola-based regimens ( n =41), were included. No treatment-related deaths occurred with CAR T vs. 3 (7.3%) with Pola. The overall and complete response rates were 83% and 58% with CAR T vs. 66% and 44% with Pola-based-regimens ( p =0.077 and p =0.18, respectively). At a median follow-up of 9 months (range 1–19.2) and 16 months (range 0.7–25.3) for the CAR T and Pola arm respectively, the median PFS has not been reached for CAR T vs. 5.6 months for Pola (95% CI 3.6–7.6, p =0.014). Median OS has not been reached for CAR T vs. 10.8 months (95% CI 2.2–19.4) for Pola ( p =0.026). To conclude, in a real-world setting, treatment with CAR T achieved superior PFS and OS compared to Pola-based regimens in patients with R/R DLBCL.