Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI.
ADC Therapeutics, New Providence, NJ.
Clin Lymphoma Myeloma Leuk. 2022 Jun;22(6):373-381. doi: 10.1016/j.clml.2021.11.011. Epub 2021 Nov 22.
The treatment landscape for diffuse large B-cell lymphoma (DLBCL) has recently changed. We examined characteristics and clinical outcomes of DLBCL patients who initiated a third (3L) and fourth (4L) line of therapy during a contemporary time frame.
Adult patients diagnosed with DLBCL who received ≥ 3L after January 1, 2014 were selected from the COTA database. Patients were grouped into cohorts by 3L or 4L initiation and further stratified by type of treatment received: chemotherapy or chemoimmunotherapy (CT/CIT), targeted therapy (TT), chimeric antigen receptor T cells (CAR-T), or salvage therapy consolidated with hematopoietic cell transplant (HCT). Patient characteristics, response rates, and overall survival (OS) were examined.
Among adult patients with relapsed/refractory (r/r) DLBCL, 212 (mean age; 61.8 years; 59.0% male) received their 3L and 127 (mean age: 61.0 years; 61.4% male) their 4L. Among those treated with their 3L and 4L, 55.2% and 50.4%, respectively, received CT/CIT; 26.9% and 34.6% received TT. The complete response rate of 3L patients was 9.4% for CT/CIT, 10.5% for TT, and 60% for CAR-T. Similar findings were seen with 4L patients (CT/CIT: 6.3%; TT: 15.9%; CAR-T: 53.8%). For those who received pharmacological treatment in 3L and 4L, median OS times were 7.7 and 4.4 months, respectively. Median OS times of patients who received cell-based therapies (CAR-T/HCT) were not reached.
In this study, a majority of r/r DLBCL patients were treated with CT/CIT or TT in 3L and 4L settings and had poor clinical outcomes, underscoring the need for more effective treatments.
弥漫性大 B 细胞淋巴瘤（DLBCL）的治疗格局最近发生了变化。我们研究了在当代时间框架内开始接受三线（3L）和四线（4L）治疗的 DLBCL 患者的特征和临床结局。
从 COTA 数据库中选择了 2014 年 1 月 1 日以后诊断为 DLBCL 并接受了≥3L 治疗的成年患者。患者按 3L 或 4L 起始分组，并进一步按接受的治疗类型分层：化疗或化疗免疫治疗（CT/CIT）、靶向治疗（TT）、嵌合抗原受体 T 细胞（CAR-T）或挽救性治疗联合造血细胞移植（HCT）。检查了患者特征、反应率和总生存率（OS）。
在复发/难治性（r/r）DLBCL 成年患者中，212 例（平均年龄 61.8 岁；59.0%为男性）接受了 3L 治疗，127 例（平均年龄 61.0 岁；61.4%为男性）接受了 4L 治疗。在接受 3L 和 4L 治疗的患者中，分别有 55.2%和 50.4%接受了 CT/CIT；分别有 26.9%和 34.6%接受了 TT。3L 患者 CT/CIT 的完全缓解率为 9.4%，TT 为 10.5%，CAR-T 为 60%。4L 患者也观察到类似的发现（CT/CIT：6.3%；TT：15.9%；CAR-T：53.8%）。对于那些在 3L 和 4L 接受药物治疗的患者，中位 OS 时间分别为 7.7 个月和 4.4 个月。接受细胞治疗（CAR-T/HCT）的患者中位 OS 时间未达到。
在这项研究中，大多数 r/r DLBCL 患者在 3L 和 4L 治疗中接受了 CT/CIT 或 TT 治疗，临床结局较差，这突出表明需要更有效的治疗方法。
