What is the role of chemoimmunotherapy in the treatment of relapsed/refractory diffuse large B-cell lymphoma (DLBCL)?

Updated: Aug 20, 2020
  • Author: Shipra Gandhi, MBBS; Chief Editor: Emmanuel C Besa, MD  more...
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In June 2019, polatuzumab vedotin, a CD79b-directed antibody-drug conjugate, gained accelerated approval from the FDA for adults with relapsed or recurrent DLBCL in combination with bendamustine and a rituximab product after at least 2 prior therapies. 

Accelerated approval of polatuzumab was based on a study in which 40% of patients treated with polatuzumab vedotin plus BR achieved CR (n=16/40; 95% CI: 25-57) compared with 18% of those receiving BR alone (n=7/40; 95% CI: 7-33). The study also showed an OR of 45% with polatuzumab plus BR at the end of treatment (n=18/40; 95% CI: 29-62) compared with 18% for BR alone (n=7/40; 95% CI: 7-33). Of patients who achieved a complete or partial response, duration of response was at least 6 months in 64% (n=16/25) of those receiving polatuzumab plus BR, compared with 30% (n=3/10) for BR alone. Additionally, response lasting at least 1 year was observed in 48% (n=12/25) of patients receiving polatuzumab plus BR compared with 20% (n=2/10) for BR alone. [80]

In July 2020, FDA granted accelerated approval to tafasitamab (Monjuvi), a humanized Fc-modified cytolytic CD19 targeting monoclonal antibody, in combination with lenalidomide for the treatment of relapsed or refractory DLBCL not otherwise specified, including DLBCL arising from low-grade lymphoma, in adults who are ineligible for autologous stem cell transplant (ASCT). Approval was based on data from Phase 2 L-MIND study, an open label, multicenter, single arm trial of Monjuvi in combination with lenalidomide as a treatment for adult patients with relapsed or refractory DLBCL. The study showed an overall response rate (ORR) of 55%, including a CR rate of 37% and a PR rate of 18%. The median duration of response (mDOR) was 21.7 months. [123]

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