TY - JOUR

T1 - Real-world outcomes following third or subsequent lines of therapy

T2 - A Danish population-based study on 189 patients with relapsed/refractory large B-cell lymphomas

AU - AL-Mashhadi, Ahmed Ludvigsen

AU - Jakobsen, Lasse Hjort

AU - Brown, Peter

AU - Gang, Anne Ortved

AU - Thorsteinsson, Anne Luise

AU - Rasoul, Kaziwa

AU - Haissman, Judith Melchior

AU - Tøstesen, Michael Buch

AU - Christoffersen, Mette Niemann

AU - Jelicic, Jelena

AU - Jørgensen, Jennifer Bøgh

AU - Thomsen, Troels

AU - Dessau-Arp, Andriette

AU - Andersen, Andreas P.H.

AU - Frederiksen, Mikael

AU - Pedersen, Per Trøllund

AU - Clausen, Michael Roost

AU - Jørgensen, Judit Meszaros

AU - Poulsen, Christian Bjørn

AU - El-Galaly, Tarec Christoffer

AU - Larsen, Thomas Stauffer

N1 - Publisher Copyright: © 2023 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.

PY - 2024

Y1 - 2024

N2 - Outcome data of patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) beyond the second line are scarce outside of clinical trials. Novel therapies in the R/R setting have been approved based on single-arm trials, but results need to be contextualized by real-world outcomes. Medical records from 3753 Danish adults diagnosed with DLBCL were reviewed. Patients previously treated with rituximab and anthracycline-based chemotherapy who received the third or later line (3 L+) of treatment after 1 January 2015, were included. Only 189 patients with a median age of 71 years were eligible. The median time since the last line of therapy was 6 months. Patients were treated with either best supportive care (22%), platinum-based salvage therapy (13%), low-intensity chemotherapy (22%), in clinical trial (14%) or various combination treatments (32%). The 2-year OS-/PFS estimates were 25% and 12% for all patients and 49% and 17% for those treated with platinum-based salvage therapy. Age ≥70, CNS involvement, elevated LDH and ECOG ≥2 predicted poor outcomes, and patients with 0–1 of these risk factors had a 2-year OS estimate of 65%. Only a very small fraction of DLBCL patients received third-line treatment and were eligible for inclusion. Outcomes were generally poor, but better in intensively treated, fit young patients with limited disease.

AB - Outcome data of patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) beyond the second line are scarce outside of clinical trials. Novel therapies in the R/R setting have been approved based on single-arm trials, but results need to be contextualized by real-world outcomes. Medical records from 3753 Danish adults diagnosed with DLBCL were reviewed. Patients previously treated with rituximab and anthracycline-based chemotherapy who received the third or later line (3 L+) of treatment after 1 January 2015, were included. Only 189 patients with a median age of 71 years were eligible. The median time since the last line of therapy was 6 months. Patients were treated with either best supportive care (22%), platinum-based salvage therapy (13%), low-intensity chemotherapy (22%), in clinical trial (14%) or various combination treatments (32%). The 2-year OS-/PFS estimates were 25% and 12% for all patients and 49% and 17% for those treated with platinum-based salvage therapy. Age ≥70, CNS involvement, elevated LDH and ECOG ≥2 predicted poor outcomes, and patients with 0–1 of these risk factors had a 2-year OS estimate of 65%. Only a very small fraction of DLBCL patients received third-line treatment and were eligible for inclusion. Outcomes were generally poor, but better in intensively treated, fit young patients with limited disease.

KW - chemotherapy

KW - clinical research

KW - epidemiology

KW - lymphomas

KW - malignant lymphomas

U2 - 10.1111/bjh.19201

DO - 10.1111/bjh.19201

M3 - Journal article

C2 - 38009548

AN - SCOPUS:85177827416

VL - 204

SP - 839

EP - 848

JO - British Journal of Haematology

JF - British Journal of Haematology

SN - 0007-1048

IS - 3

ER -