Background

Outcomes in patients with relapsed/refractory (R/R) diffuse large b-cell lymphoma (DLBCL) who are ineligible for and/or fail high-dose chemotherapy and autologous stem cell transplantation in the second line are poor. There is no preferred palliative-intent treatment for patients in this setting.

Patients and Methods

A retrospective cohort study was performed using the nationwide de-identified electronic health record-derived Flatiron Health database. Event-free survival (EFS) and overall survival (OS) was evaluated for patients with R/R DLBCL who were ineligible for and/or failed autologous stem cell transplantation in the second line and received bendamustine, gemcitabine, or lenalidomide.

Results

Three hundred eighty-three patients were included. Therapy received was bendamustine in 158 patients, gemcitabine in 142 patients, and lenalidomide in 83 patients. The median EFS and OS for all patients was 4.1 months and 8.7 months, respectively. Compared with patients receiving bendamustine or gemcitabine, those receiving lenalidomide demonstrated significantly longer median EFS (6.8 vs. 3.8 months; P = .006) and median OS (15.4 vs. 7.7 months; P = .045). Survival outcomes were also improved for lenalidomide-treated patients specifically in the second- as well as third- or fourth-line settings.

Conclusion

Use of lenalidomide resulted in prolonged EFS and OS as compared with bendamustine or gemcitabine in this cohort of patients with R/R DLBCL receiving palliative therapy. This first large-scale analysis of real-world outcomes for this patient population may guide current clinical management as well as serve as a benchmark for survival outcomes in the standard-of-care setting, which may aid in the design of future clinical trials.

中文翻译：

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接受姑息治疗的复发性/难治性弥漫性大 B 细胞淋巴瘤患者的真实世界结果。

背景

复发/难治性 (R/R) 弥漫性大 B 细胞淋巴瘤 (DLBCL) 患者在二线治疗中不适合和/或失败高剂量化疗和自体干细胞移植的结果很差。在这种情况下，患者没有首选的姑息治疗。

患者和方法

使用全国性去识别化电子健康记录衍生的 Flatiron Health 数据库进行了一项回顾性队列研究。对于不适合和/或二线自体干细胞移植失败并接受苯达莫司汀、吉西他滨或来那度胺治疗的 R/R DLBCL 患者，评估了无事件生存期 (EFS) 和总生存期 (OS)。

结果

包括三百八十三名患者。158 名患者接受了苯达莫司汀治疗，142 名患者接受了吉西他滨治疗，83 名患者接受了来那度胺治疗。所有患者的中位 EFS 和 OS 分别为 4.1 个月和 8.7 个月。与接受苯达莫司汀或吉西他滨的患者相比，接受来那度胺的患者表现出显着更长的中位 EFS（6.8 与 3.8 个月；P  = .006）和中位 OS（15.4 与 7.7 个月；P  = .045）。特别是在二线、三线或四线环境中，接受来那度胺治疗的患者的生存结果也得到了改善。

结论

在接受姑息治疗的 R/R DLBCL 患者队列中，与苯达莫司汀或吉西他滨相比，使用来那度胺导致 EFS 和 OS 延长。对这一患者群体的真实世界结果的首次大规模分析可能会指导当前的临床管理，并作为标准护理环境中生存结果的基准，这可能有助于设计未来的临床试验。