Efficacy and relapse profiles of Pola-R-CHP versus R-CHOP in previously untreated diffuse large B-cell lymphoma: A...

In this retrospective, multicentre cohort study, we compared the real-world efficacy of polatuzumab vedotin combined with rituximab, cyclophosphamide, doxorubicin and prednisone (Pola-R-CHP) versus the conventional rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) in 370 patients in the propensity score matching cohort from 1096 patients with previously untreated diffuse large B-cell lymphoma (DLBCL) (pola; n = 185 in the matched and 356 in the full cohort). The analysis focused on clinical efficacy, the prognostic performance of established risk models and the relapse profiles with the chemotherapies. The Pola-R-CHP group showed superior 1-year progression-free survival (PFS) compared to the R-CHOP group (86.7% vs. 73.5%, p = 0.027); however, the 1-year overall survival (OS) was similar (92.8% vs. 89.6%, p = 0.24). Within the Pola-R-CHP group, the Central Nervous System International Prognostic Index (CNS-IPI) effectively stratified the cumulative incidence of CNS relapse of 0%, 2.1% and 4.5% in the low, intermediate and high-risk groups respectively (p = 0.023). Additionally, the 1-year incidence of nodal relapse was significantly lower in the Pola-R-CHP group than in the R-CHOP group (2.1% vs. 10.9%, p = 0.013), whereas the incidence of extra-nodal relapse remained similar (3.8% vs. 5.2%, p = 0.57). These findings underscore the clinical efficacy of Pola-R-CHP over R-CHOP in first-line DLBCL treatment. However, early extra-nodal relapse and CNS relapse remained a therapeutic challenge.