Polatuzumab Vedotin Combined With R-ICE (PolaR-ICE) as Second-Line Therapy in Diffuse Large B-Cell Lymphoma

Area of Science:

• Hematology
• Oncology
• Clinical Trials

Background:

• Salvage chemoimmunotherapy with autologous stem cell transplantation (ASCT) is standard for relapsed/refractory (r/r) diffuse large B-cell lymphoma (DLBCL) >1 year post-frontline therapy.
• The study accrued patients before the widespread approval of second-line CAR T-cell therapies.

Purpose of the Study:

• To evaluate the safety and efficacy of polatuzumab vedotin (Pola) combined with R-ICE salvage chemotherapy for r/r DLBCL.
• To assess if PolaR-ICE followed by post-ASCT Pola maintenance improves complete response (CR) rates and post-ASCT outcomes.
• To investigate outcomes in patients with early vs. late relapse.

Main Methods:

• Forty-one patients with r/r DLBCL received PolaR-ICE salvage chemotherapy.
• Patients undergoing ASCT received subsequent Pola consolidation.
• Safety and efficacy endpoints included overall response rate (ORR), CR rate, progression-free survival (PFS), and overall survival (OS).

Main Results:

• The ORR was 88% with a 56% CR rate after PolaR-ICE salvage.
• Twenty-two patients (56%) proceeded to ASCT, and 16 (39%) received Pola consolidation.
• At 25 months median follow-up, 2-year PFS was 49.9% and 2-year OS was 75.0%.
• Patients with late relapse (≥12 months) had significantly better 2-year PFS (80.0%) compared to early relapse (≤12 months) (36.4%).

Conclusions:

• Pola-RICE is a safe and effective salvage regimen for r/r DLBCL, with manageable toxicities.
• This regimen can improve CR rates and post-ASCT outcomes.
• Pola-RICE is a viable option for patients with late relapse or in settings with limited CAR T-cell therapy access.