Real-World Treatment Pathways of Patients With Diffuse Large B-Cell Lymphoma Receiving Second Line Treatment or Later in the UK, Canada, France, Germany, Italy and Spain: A Prospective Survey of Physicians

OBJECTIVES: Diffuse large B-cell lymphoma (DLBCL) represents 40% of all non-Hodgkin Lymphoma cases. However, research into 2^nd line or later (2L+) treatment pathways of real-world patients is limited. Consequently, this analysis explores this further.

METHODS: Data were drawn from the Adelphi DLBCL Disease Specific Programme™ (DSP), a point-in-time survey of clinicians and their patients. Between January-May 2021, physicians in France, Germany, Italy, Spain, the United Kingdom and Canada recruited their next 6 presenting patients with DLBCL who met a predefined quota (1L; n=1, 2L; n=3, 3L+; n=2 at time of data collection).

RESULTS: Data were collected on 1,040 2L+ DLBCL patients. At data collection, 625 patients had complete data up to 2L and 415 patients up to 3L+. Mean age was 66 (SD: 12.5) years and 59% were male.

Of 1,040 patients, 451 (43%) became relapsed/refractory within 12 months of 1L treatment end (r/r <12m of 1L end) with a median time to relapse of 118.0 days. Of the n=188 patients that were r/r <12m of 1L end and had complete data up to 3L+, 40 (21%) received high-dose therapy with stem cell transplant (HDT-SCT) at 2L. Subsequently, median time from HDT-SCT to relapse/refractory in these patients was 142.5 days, after which 53% proceeded to receive chimeric antigen receptor T-cell (CAR-T) therapy at 3L.

CONCLUSIONS: Few 3L+ patients that were r/r <12m of 1L end received HDT-SCT at 2L. Of those who did receive HDT-SCT, a large proportion relapsed within 5 months, and over half of these patients went onto receive CAR-T at 3L. However, as these patients were actively treated at 3L+, data reported does not account for patients who did not progress to 3L. Nonetheless, this highlights a group of patients for which HDT-SCT is not curative, indicating unmet need for alternative treatment options at 2L.