Descriptive analysis of the efficacity of R-GEMOX /R-IE/R-CEPP in patients with relapsed/refractory (R/R) transplant-ineligible diffuse large B-cell lymphoma (DLBCL)

Abstract

Background

Patients with Relapsed/Refractory (R/R) Diffuse Large B-Cell Lymphoma (DLBCL) ineligible for Hematopoietic Stem Cell Transplantation (HSCT) may benefit from a second line anticancer drug regimen but real-life outcomes are lacking.

Objective

To describe the efficacity of 3 anticancer drug regimens (Gemcitabine and Oxaliplatin GEMOX; Ifosfamide and Etoposide IE; Cyclophosphamide, Etoposide, Procarbazine and Prednisone CEPP) combined with Rituximab (R-) in terms of progression-free (PFS) and overall survival (OS).

Patients

Retrospective study including R/R DLBCL patients HSCT ineligible who received at least one cycle of R-GEMOX, R-IE or R-CEPP between 2010 and 2022. Demographic, clinical, biological and survival data were collected. Univariate and multivariate analysis were performed to identify associated variables with survival outcomes.

Results

Sixty-two patients (median age 78 [40–102] with predominantly stage III-IV DLBCL (n = 49, 79%), non-germinal center-B like (n = 27, 44%) were included. Median OS and PFS were 9 (CI95% [3–10]) and 4 months (CI95% [2–13]) for R-GEMOX, 4 (CI95% [2–6]) and 1 month (CI95% [1–4]) for R-IE and 5 (CI95% [3–6]) and 3 months (CI95% [2–15]) for R-CEPP, respectively. Univariate analysis selects ECOG, aa-IPI scores, LDH rate and Ann-Arbor stage with no independently association in multivariate analysis.

Conclusion

All three regimens show modest survival benefit especially between last anticancer treatment course and death. Emergence of bispecific antibodies and Cart-cells for which real-life benefits have yet to be demonstrated could be coupled with improved access to early palliative care.