Patients with diffuse large B-cell lymphoma (DLBCL) benefit from improved survival outcomes when treated with a combination therapy rather than monotherapy, according to research presented at the 22nd Congress of the European Hematology Association (June 22-25, 2017; Madrid, Spain).
Currently recommended first-line therapy for patients with DLBCL who can tolerate therapy is rituximab plus chemotherapy. For those patients with relapsed or refractory disease, high-dose chemotherapy with either stem cell transplant or rituximab as monotherapy or in combination are considered. Efficacy of rituximab in this population has been previously validated, but limited research exists regarding survival outcomes in patients seen in routine clinical care.
Aaron Galaznik, MD, Millennium Pharmaceuticals, Inc (Cambridge, MA), and colleagues evaluated survival outcomes of patients with newly diagnosed DLBCL seen in routine clinical care from Humedica—a United States electronic medical record database—between 2008 and 2015. A total of 1436 patients (mean age, 66.4 years) with DLBCL were selected with at least one documentation of inpatient record or at least two outpatient records with DLBCL diagnosis codes. Primary outcomes included median progression-free survival (PFS), median overall survival (OS), and PFS and OS rates at two years following initiation of first-line treatment.
Researchers observed that 92.1% of patients received combination therapy, with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (63.5%) the most common regimen. A total of 7.9% of patients received monotherapy upfront, with rituximab (77.2%) the most common single agent.
At two years following first-line initiation, OS and PFS among the entire sample was 79.2% and 67.3%, respectively. Median OS was not reached, and median PFS was 53.9 months (95% CI, 45.2-61.5).
Researchers also found that after two years follow-up, OS was 80.2% for patients receiving combination therapy compared with 67.4% for patients receiving monotherapy. In this same analysis, PFS was 68.3% for patients receiving combination therapy compared with 55.1% for patients receiving monotherapy.
Authors of the study concluded that, “In this population of patients with newly diagnosed DLBCL receiving [first-line therapy], survival outcomes at two years were significantly improved for patients treated with combination therapy versus monotherapy.”
Further research is underway to examine the differences in clinical characteristics of patients with DLBCL in the first-line setting.—Zachary Bessette
