Journal: Blood cancer journal
This publication reports a large real-world analysis of 9,875 adults with diffuse large B‑cell lymphoma (DLBCL) treated between October 2015 and June 2024, focusing on treatment patterns, sequencing, and outcomes across lines of therapy.
Key points:
- First-line therapy (1L):
- • R‑CHOP–based regimens remained the dominant initial treatment, accounting for ~62–67% of 1L therapy from 2016–2023, decreasing to 49.4% in 2024, suggesting gradual diversification of frontline approaches.
- • Median overall survival (OS) from start of 1L was 58.1 months.
- • Median time to next treatment (TTNT) after 1L was 36.1 months.
- • Despite established frontline therapy, 12‑month treatment failure was still substantial at 36%.
- Second-line therapy (2L):
- • Use of conventional chemoimmunotherapy declined markedly over time in 2L (from 81.6% in 2016 to 41.9% in 2024), with a corresponding rise in “novel” agents (43.0% of 2L regimens in 2024).
- • Median OS decreased to 30.0 months at 2L.
- • Median TTNT at 2L shortened to 10.6 months, indicating faster attrition and need for subsequent therapy.
- • Twelve‑month treatment failure increased to 51.8% after 2L.
- Later lines, CAR T, and SCT:
- • In 3L, conventional chemoimmunotherapy use also declined (47.6% in 2016 to 22.1% in 2024), with novel therapies reaching 55.9% of regimens by 2024.
- • CAR T‑cell therapy was used across various lines; among CAR T recipients, 42.2% experienced treatment failure by 12 months.
- • Post–CAR T management was highly heterogeneous: 93 patients went on to receive 36 different subsequent regimens, underscoring the absence of a clear, standardized post–CAR T treatment paradigm.
- • Autologous stem cell transplant remained part of 2L management for some patients, though the abstract does not quantify outcome differences by SCT status.
- Overall implications:
- • While therapeutic options for DLBCL have expanded and novel agents are increasingly used beyond 1L, clinical outcomes deteriorate with each successive line, with shorter TTNT and higher early failure rates.
- • The data highlight particularly high unmet need in the relapsed/refractory and post–CAR T settings, where no consistent standard of care has emerged and outcomes remain poor.