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    Home > Active Ingredient News > Blood System > New thinking on diagnosis and treatment of DLBCL in the first treatment of DLBCL in intensive reading of the first issue of Qunyinghui

    New thinking on diagnosis and treatment of DLBCL in the first treatment of DLBCL in intensive reading of the first issue of Qunyinghui

    • Last Update: 2022-04-29
    • Source: Internet
    • Author: User
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    The introduction of "Club Yinghui - Lymphoma Diagnosis and Research Interpretation Series" is an exclusive academic exchange platform for young and middle-aged hematologists.
    To summarize the optimized diagnosis and treatment strategies for lymphoma to improve the survival rate of Chinese lymphoma patients
    .

    In this issue, Prof.
    Zhang Wei from Peking Union Medical College Hospital and Prof.
    Li Zhiming from Sun Yat-Sen University Cancer Center are the chairmen of the conference.
    Prof.
    Zhang Yuanfeng from Yantai Yuhuangding Hospital and Prof.
    Zhou Zhiyuan from the First Affiliated Hospital of Zhengzhou University interpret the field of diffuse large B-cell lymphoma (DLBCL) for everyone.
    and invited Professor He Jianxia from the Department of Hematology of Shanxi Provincial People's Hospital and Professor Sun Xiuli from the First Affiliated Hospital of Dalian Medical University to participate in the exchange and discussion.
    The highlights of this session are now organized as follows
    .

    Intensive literature reading (1) PFS24 may predict long-term survival in newly diagnosed DLBCL patients Professor Zhang Yuanfeng shared an article published by Ann Oncol entitled "Progression-free survival at 24 months (PFS24) and subsequent outcome for patients with diffuse large B-cell lymphoma (DLBCL) enrolled on randomized clinical trials (24-month progression-free survival (PFS24) rate and follow-up outcomes of DLBCL patients enrolled in randomized clinical trials)” [1]
    .

    The study is the world's largest study of DLBCL patients in the era of immunochemotherapy.
    A large number of prospective data were collected, combined with data from multiple randomized controlled clinical trials, with good statistical significance
    .

    Study Design The study included 5835 patients receiving rituximab and anthracyclines as first-line therapy, with a median age of 62 years, 57% elevated lactate dehydrogenase (LDH), and 63% Ann Arbor stage III/ Stage IV, 13% with an ECOG score of 2-4
    .

    PFS24 was defined as survival without disease progression within 24 months of starting treatment
    .

    Overall survival (OS) in patients with PFS24 was defined as the time from reaching PFS24 to death from any cause
    .

    Results Of the evaluable patients, 1423 patients did not achieve PFS24, the 5-year OS rate was only 19%, and the median OS was only 7.
    2 months; 3678 patients achieved PFS24, and the OS of patients with PFS24 was comparable to that of the matched normal population.
    In agreement, the 5-year OS rates were 87.
    6% vs 89.
    5%, respectively (Figure 1)
    .

    Figure 1 OS in patients who did not achieve vs.
    PFS24 The study also performed subgroup analyses of patients with different baseline characteristics
    .

    The 5-year predicted OS of PFS24 patients was comparable to the matched normal population regardless of age, sex, and stage
    .

    Notably, there was a more pronounced difference in expected survival between patients with higher IPI scores (4–5 points) at diagnosis and the normal population (Table 1)
    .

    Table 1 Estimated 3-year, 5-year and 7-year OS rates in patients with PFS24 vs normal population Study Conclusions If the first-line treatment of DLBCL patients achieves PFS24, a good long-term OS rate can be obtained
    .

    PFS24 may become a reliable indicator for evaluating the success of first-line treatment, but this study also has certain limitations and is not suitable for patients with DLBCL who receive maintenance therapy and relapse
    .

    Expert Hotspot Discussion After Professor Zhang Yuanfeng's wonderful interpretation, many experts discussed whether PFS24 has actual clinical value
    .

    Prof.
    He Jianxia said that PFS24 is a late evaluation indicator as a clinical prognostic indicator.
    In work, the prognosis of patients can be generally judged by mid-term evaluation during treatment.
    However, PFS24 may be used as a surrogate indicator for OS in clinical trials to a certain extent.
    is meaningful
    .

    Professor Zhang Wei added that the study is different from the real-world situation, such as the patient's baseline characteristics (a lower distribution of IPI score and ECOG score) and the actual clinical situation
    .

    In addition, the treatment of clinical trials is often very standardized, and more individualized treatment methods are adopted in the clinic, such as the initiation of high-intensity chemotherapy
    .

    Therefore, the revelation brought by this study is more that patients with PFS24 do not need overtreatment, and the OS is basically equivalent to that of the normal population
    .

    Intensive reading of the literature (2) Pola-R-CHP, for R-CHOP+X to explore "saving face" Prof.
    Zhiyuan Zhou shared a new article published in the New England Journal of Medicine (N Engl J Med) titled "Polatuzumab Vedotin in Previously Untreated Diffuse Large B-Cell Lymphoma (Polatuzumab Vedotin, referred to as Pola in the treatment of newly diagnosed DLBCL)” [2]
    .

    The POLARIX study is the first in more than two decades to demonstrate superiority over rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP ) scheme test
    .

    STUDY DESIGN A total of 879 patients with newly diagnosed DLBCL were included in this study.
    The median age was 65 years.
    The ECOG PS score was 0-2.
    Most of the patients were intermediate and high-risk patients.
    62.
    0% of the patients had an IPI score of 3-5
    .

    Randomized 1:1 to receive 6 cycles of Pola in combination with rituximab, cyclophosphamide, doxorubicin, prednisone (Pola-R-CHP) or R-CHOP, and 2 cycles of rituximab alone drug treatment
    .

    Baseline characteristics of the two groups were balanced
    .

    Figure 2 POLARIX study design Study results At a median follow-up of 28.
    2 months, the 2-year progression-free survival (PFS) rate of the Pola-R-CHP group was improved by 6.
    5% (76.
    7% [95% CI 95% CI] compared with the R-CHOP group.
    , 72.
    7-80.
    8] vs 70.
    2% [95%CI, 65.
    8-74.
    6], P=0.
    02, Figure 3)
    .

    The Pola-R-CHP group had a lower relative risk of events than the R-CHOP group, with 2-year event-free survival (EFS) rates of 75.
    6% and 69.
    4%, respectively (HR 0.
    75; 95% CI: 0.
    58-0.
    96; P=0.
    02, Figure 4), with statistical significance
    .

    Figure 3 2-year PFS of Pola-R-CHP vs R-CHOPFigure 4 2-year EFS of Pola-R-CHP vs R-CHOP Although the complete remission (CR) rate was not statistically different between the two groups (78.
    0% vs 74.
    0%, P=0.
    16), but disease-free survival (DFS) analysis suggested that the Pola-R-CHP group had better quality of response and longer duration of response (HR 0.
    70; 95% CI: 0.
    50-0.
    98, Figure 5)
    .

    A significant difference in OS between the two groups was not observed (HR 0.
    94; 95% CI: 0.
    65–1.
    37; P=0.
    75, Figure 6)
    .

    Figure 5 2-year DFS of Pola-R-CHP vs R-CHOPFigure 6 PFS subgroup analysis of 2-year OS rate of Pola-R-CHP vs R-CHOP DLBCL-naïve patients with IPI score of 3-5, large mass, ABC subtype, and double expression) all achieved good PFS benefit, and the risk of recurrence, progression, and death was significantly reduced (Figure 7)
    .

    Figure 7 PFS subgroup analysis The safety of the Pola-R-CHP group was comparable to the R-CHOP group, but the Pola-R-CHP group had fewer adverse events (AEs) leading to dose reductions
    .

    The most common AE in both groups was peripheral neuropathy, but was better tolerated in the Pola-R-CHP group
    .

    Conclusions This study has brought a major breakthrough in the field of DLBCL, and the data support the use of Pola-R-CHP in the first-line treatment of DLBCL
    .

    Experts' hot discussion After Professor Zhou Zhiyuan's wonderful interpretation, many experts discussed the breakthrough exploration of first-line treatment of DLBCL
    .

    Professor Li Zhiming concluded that the global phase III POLARIX study, as an inter-generational study, has far-reaching significance and truly "saved face" for the exploration of R-CHOP+X
    .

    In addition, a phase II study of the molecular typing-based R-CHOP+X regimen in the treatment of newly diagnosed DLBCL patients conducted by the team of Prof.
    Zhao Weili from Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine also showed that precise typing can bring better benefits to patients.
    Evidence of treatment benefit, future exploration of new first-line DLBCL clinical trials should be based on the latest POLARIX research evidence, and further exploration on the basis of Pola-R-CHP
    .

    This issue of "Club Yinghui - Lymphoma Diagnosis and Treatment Research Interpretation Series" has been successfully concluded.
    See you in the next issue! Next notice: Qunyinghui | Lymphoma Diagnosis and Treatment Research Interpretation Series - Session 2 Qunyinghui | Lymphoma Diagnosis and Research Interpretation Series - Third Reference: 1.
    MJ Maurer, et al.
    Progression-free survival at 24 months (PFS24) and subsequent outcome for patients with diffuse large B-cell lymphoma (DLBCL) enrolled on randomized clinical trials.
    Ann Oncol .
    2018 Aug 1;29(8):1822-1827.
    doi: 10.
    1093/annonc/mdy203.
    2 .
    Hervé Tilly, et al.
    Polatuzumab Vedotin in Previously Untreated Diffuse Large B-Cell Lymphoma.
    N Engl J Med.
    2022 Jan 27;386(4):351-363.
    doi: 10.
    1056/NEJMoa2115304.
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