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.