EHA 2025 | Real-world outcomes of frontline Pola-R-CHP in diffuse large B-cell lymphoma

Based on the study of the Polarix trial, now we have five-year follow-up results presented at ASH. Pola-R-CHP has become a standard FDA-approved frontline therapy for diffuse large B-cell lymphoma. To better understand real-world outcomes of this regimen as clinical trials are very selective in their inclusion criteria, we performed a multi-center retrospective study, including patients from 17 U.S. centers who received treatment, who received Pola-R-CHP standard of care for frontline DLBCL. We had a total of 535 patients treated with Pola-R-CHP between August of 2021 and September of 2024. And patients, the median age was 67, 17% had ECOG performance that was two or higher, 89% had advanced stage, and 63% had an IPI 3 to 5, 33% bulky disease. And we also had 3% of patients with central nervous system involvement. In terms of cell of origin, 34% had GCB subtype and 59% had non-GCB subtype by Hans. With respect to efficacy, the overall response rate was 92% in all the patients with CR rate of 80%. And outcomes response rates are very comparable when looking at GCB versus non-GCB patients. At a median follow-up of 11 months, the one-year PFS was 81% among all the patients. And again, comparable PFS in the GCB versus non-GCB group. And one-year overall survival was 91% among all the patients with the same one-year overall survival in both cell of origin subgroups. With respect to safety, 37% of patients had any grade neuropathy. 1.1% of patients had high-grade neuropathy. 20% of patients had high-grade infection, 3% had cardiomyopathy, 31% had high-grade neutropenia, and 15% had grade 3 or higher febrile neutropenia. 31% of patients were hospitalized and 6% had ICU admissions for treatment-related adverse events. Treatment was discontinued due to toxicity in 13% of patients and progression in 3.6% of patients. In terms of looking at risk factors for inferior outcomes in our cohort of real-world patients receiving this regimen in the frontline setting. The risk factors for inferior outcomes included over one extranodal site, bulky disease, CNS involvement, and double and triple hit, which were associated with inferior PFS, and high ECOG status, higher than two, elevated LDH, and IPI 3 to 5 were associated with inferior overall survival and PFS. Interestingly, cell of origin was not associated with inferior PFS or overall survival outcomes in our study. So I think overall, our study really suggests that standard of care Pola-R-CHP for frontline DLBCL is very safe and effective, and outcomes are very similar compared to those found in the Polarix study, even in the real-world setting. And there were no significant differences in outcomes based on the cell of origin in this cohort.

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