Certain treatment regimens and specific chemotherapeutic drugs could be superior to other options for patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL), according to a study recently published in Pharmacological Research.

“In addition, compared with patients who did not receive chemotherapy, those who did were found to have significantly improved [objective response rate (ORR)] and [progression-free survival (PFS)], although no apparent benefit was detected with respect to [overall survival (OS)],” the authors wrote.

This model-based meta-analysis included 58 published articles, which accounted for 68 clinical trials and 3124 patients. The researchers analyzed 11 different treatment schemes and 63 detailed treatment regimens. Among the therapeutic approaches were chemotherapy, targeted therapy, and immunotherapy.

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Perhaps the biggest takeaway was that association therapy showcased significant increases in OS, PFS, and ORR when compared to monotherapy. Interestingly, chemotherapy, either alone or combined, also correlated with better ORR and PFS rates but yielded no difference in OS.

Among all treatment combinations, 5 exhibited better efficacy: the combination of 2 different immunotherapies, chemotherapy combined with immunotherapy, chemotherapy with immunotherapy sequential autologous stem cell transplantation (ASCT), chemotherapy sequential ASCT, and chemotherapy with 2 different types of immunotherapy.

Specifically, rituximab in combination with inotuzumab ozogamicin showcased the highest OS at 48.2 months, followed by rituximab in association with carmustine, etoposide, cytarabine, and melphalan sequential ASCT (R-BEAM+ASCT) with an OS of 34.2 months.

The following 3 regimens were associated with an OS of less than 30 months: rituximab in combination with lenalidomide, etoposide, cisplatin, cytarabine, and methylprednisolone; iodine-131 tositumomab combined with BEAM sequential ASCT; and chemotherapy sequential chimeric antigen receptor T-cell immunotherapy, with OS times of 27.8, 25.8, and 25 months, respectively.

“Moreover, with respect to association therapy, there was a strong correlation between the 6-month PFS and 2-year OS,” the authors highlighted.

Finally, although the benefits of chemotherapy are clear, it is still challenging to ensure its safety since it increases the risk of experiencing grade 3 to 5 adverse events in some cases.

Reference

Li T, Yu J, Hou M, et al. Quantitative evaluation of therapy options for relapsed/refractory diffuse large B-cell lymphoma: a model-based meta-analysis. Pharmacol Res. Published online December 5, 2022. doi:10.1016/j.phrs.2022.106592