Contributions
Abstract: EP1165
Type: E-Poster Presentation
Session title: Quality of life, palliative care, ethics and health economics
Background
More than one-third of patients with diffuse LBCL, the most common LBCL subtype, relapse after standard first-line therapy. Standard of care (SoC) in 2L R/R LBCL is salvage chemotherapy (CTx), followed by high-dose CTx (HDCT) and hematopoietic stem cell transplantation (HSCT) in eligible patients. However, only roughly 30% of R/R patients eventually proceed to HSCT. High-risk patients with early first-line relapse obtain only a limited survival advantage with HSCT.
Aims
We conducted an SLR to identify clinical evidence regarding the efficacy and safety of therapies used in the treatment of patients with 2L R/R LBCL, including transplant-eligible (TE) and transplant non-eligible (TNE) patients.
Methods
The Population, Intervention, Comparator, Outcome, and Study (PICOS) framework was used for the search strategy for identifying English-language publications from January 2003 to July 2020. Articles were searched in MEDLINE, Embase, and the Cochrane Library databases; abstracts were identified from key congresses (2017–2020). Selection criteria included (but were not limited to) 2L R/R LBCL, ≥25 participants per treatment arm or ≥50 per study, single- or multiagent chemotherapy or immunotherapy, chemoimmunotherapy, CAR T cell therapy, HSCT, and efficacy (overall response rate [ORR], overall survival [OS], and progression-free survival [PFS]).
Results
Of 3417 records screened, 68 were included (28 publications, 37 conference abstracts, and 3 trial records), representing 55 unique studies. Most were observational studies (n=36), followed by randomized controlled trials (n=8), single-arm trials (n=7), and nonrandomized controlled trials (n=4). Exclusions included studies that were preclinical, duplicates, or studies with incomplete data. The study populations included TE (n=15), TNE (n=9), and mixed/unspecified (n=31). Salvage CTx (with or without HSCT) was the most common treatment (n=42), followed by HSCT (n=3) and CAR T cell therapy (n=1); 6 observational studies had no specified treatment and 3 were prognostic. ORR with salvage CTx ranged from 37%–69% for TE patients (with an outlier reporting an ORR of 23% due to a high-risk population) and from 48%–74% for TNE patients. Interim efficacy data for a CAR T cell therapy in TNE patients were reported from one ongoing phase 2 trial: an ORR of 89% and a complete response rate of 56% were observed in 27 patients who received lisocabtagene maraleucel. Median OS was reported in 18 studies, ranging from 13.2–16.7 months in the intent-to-treat population of TE patients and 8.7–24.2 months in TNE patients. Median OS with HSCT in 3 studies ranged from 12.4–36.7 months.
Conclusion
Most studies in 2L LBCL explored salvage treatment regimens with intent of HDCT/HSCT follow-up treatment. Despite limited data, this SLR identified a lack of a clear SoC in TNE populations who have a dismal prognosis. Historically, ~30% of patients proceed to receive HSCT, indicating a critical need for effective therapeutic options that are more broadly accessible to all 2L patients, with a greater long-term benefit in high-risk subgroups.
Keyword(s): B cell lymphoma, Diffuse large B cell lymphoma, Refractory, Relapsed lymphoma
Abstract: EP1165
Type: E-Poster Presentation
Session title: Quality of life, palliative care, ethics and health economics
Background
More than one-third of patients with diffuse LBCL, the most common LBCL subtype, relapse after standard first-line therapy. Standard of care (SoC) in 2L R/R LBCL is salvage chemotherapy (CTx), followed by high-dose CTx (HDCT) and hematopoietic stem cell transplantation (HSCT) in eligible patients. However, only roughly 30% of R/R patients eventually proceed to HSCT. High-risk patients with early first-line relapse obtain only a limited survival advantage with HSCT.
Aims
We conducted an SLR to identify clinical evidence regarding the efficacy and safety of therapies used in the treatment of patients with 2L R/R LBCL, including transplant-eligible (TE) and transplant non-eligible (TNE) patients.
Methods
The Population, Intervention, Comparator, Outcome, and Study (PICOS) framework was used for the search strategy for identifying English-language publications from January 2003 to July 2020. Articles were searched in MEDLINE, Embase, and the Cochrane Library databases; abstracts were identified from key congresses (2017–2020). Selection criteria included (but were not limited to) 2L R/R LBCL, ≥25 participants per treatment arm or ≥50 per study, single- or multiagent chemotherapy or immunotherapy, chemoimmunotherapy, CAR T cell therapy, HSCT, and efficacy (overall response rate [ORR], overall survival [OS], and progression-free survival [PFS]).
Results
Of 3417 records screened, 68 were included (28 publications, 37 conference abstracts, and 3 trial records), representing 55 unique studies. Most were observational studies (n=36), followed by randomized controlled trials (n=8), single-arm trials (n=7), and nonrandomized controlled trials (n=4). Exclusions included studies that were preclinical, duplicates, or studies with incomplete data. The study populations included TE (n=15), TNE (n=9), and mixed/unspecified (n=31). Salvage CTx (with or without HSCT) was the most common treatment (n=42), followed by HSCT (n=3) and CAR T cell therapy (n=1); 6 observational studies had no specified treatment and 3 were prognostic. ORR with salvage CTx ranged from 37%–69% for TE patients (with an outlier reporting an ORR of 23% due to a high-risk population) and from 48%–74% for TNE patients. Interim efficacy data for a CAR T cell therapy in TNE patients were reported from one ongoing phase 2 trial: an ORR of 89% and a complete response rate of 56% were observed in 27 patients who received lisocabtagene maraleucel. Median OS was reported in 18 studies, ranging from 13.2–16.7 months in the intent-to-treat population of TE patients and 8.7–24.2 months in TNE patients. Median OS with HSCT in 3 studies ranged from 12.4–36.7 months.
Conclusion
Most studies in 2L LBCL explored salvage treatment regimens with intent of HDCT/HSCT follow-up treatment. Despite limited data, this SLR identified a lack of a clear SoC in TNE populations who have a dismal prognosis. Historically, ~30% of patients proceed to receive HSCT, indicating a critical need for effective therapeutic options that are more broadly accessible to all 2L patients, with a greater long-term benefit in high-risk subgroups.
Keyword(s): B cell lymphoma, Diffuse large B cell lymphoma, Refractory, Relapsed lymphoma