Outcomes in relapsed/refractory diffuse large B-cell lymphoma in an Asian tertiary cancer center: contemporary interventions as a benchmark for novel therapy

Recent advances have led to the approval of several new therapies for relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL). However, real-world data for treatment patterns and outcomes in R/R DLBCL in Asian countries are lacking, limiting the benchmarking of novel treatments. We conducted a retrospective single-center cohort study including 227 patients with R/R DLBCL diagnosed from 2010 to 2022. Outcomes including progression-free survival (PFS) and overall survival (OS) were assessed. Most patients (n=174, 76.7%) had advanced disease (Ann Arbor stage III-IV), with 104 (45.5%) classified as primary refractory to, or having relapsed within 6 months from completion of first-line immunochemotherapy. Patients with primary refractory disease had the worst outcomes, with a median PFS of 2.2 months, median OS of 6.2 months, and the worst response rate to second-line chemoimmunotherapy with 18.1% complete response. The majority (n=121, 53.3%) were transplant-ineligible and only 44 (19.4%) were transplanted. When comparing patients who underwent transplant with those who did not, non-transplant recipients had worse outcomes in terms of OS (HR 2.93, 95%CI 2.09-4.12, p <0.0001) and PFS (HR 2.46, 95%CI 1.79-3.37, p <0.0001). In conclusion, there remains poor outcomes for patients with R/R DLBCL. Novel therapeutics including bispecifics and CAR-T may improve outcomes of these patients.