335MO - Real-world outcomes of diffuse large B cell lymphoma treated with R-CHOP(-like) therapy in an Asian multi-ethnic population

Background

Recently, there has been significant advances in the molecular understanding and treatment landscape of diffuse large B-cell lymphoma (DLBCL). It is timely therefore to evaluate outcomes to standard therapy hitherto, so as to ascertain the real-world clinical need to adopt new strategies.

Methods

Patients (n=1071) diagnosed with DLBCL at the National Cancer Centre Singapore from 2010-2022, and treated with first-line rituximab-based regimens were retrospectively studied. Median follow-up duration was 48 months. Survival analyses were performed using the Kaplan-Meier method and multivariate Cox proportional models.

Results

The cohort consisted of 590 male and 481 female patients with a median age of 63.8 years (range, 19.3-93.6). Most were stage III-IV (60.9%) and of non-germinal center B-cell like (non-GCB) subtype by Han’s criteria (56.5%). MYC rearrangement was detected by fluorescence in-situ hybridization (86/439, 19.6%) in a subgroup with available data, as was Epstein-Barr virus (32/508, 6.3%). The vast majority received R-CHOP(-like) regimens (n=997, 93.1%), including EPOCH-R (n=95), achieving a 5-year progression-free survival (PFS) and overall survival (OS) of 64.5% and 74.7%, respectively. Age >60 years, B-symptoms, poorer ECOG scores (2-4), male sex and advanced stage were independent predictors of both worse PFS and OS. In the intermediate to high-risk subgroup (IPI scores 2-5; n=752), the 5-year PFS and OS were only 58.0% and 69.8%, respectively. EBV status, as was MYC and/or BCL2 rearrangements, were not significantly associated with survival outcomes. EPOCH-R was used more frequently than R-CHOP in patients with MYC rearrangements (n=82, p=0.0001), including those with MYC/BCL2 double-hit (n=31, p=0.0034). Notably, neither regimen significantly affected survival outcomes, both in MYC-rearranged (OS: HR=0.65, p=0.380; PFS: HR=0.61, p=0.290), and in MYC/BCL2 double-hit DLBCL (OS: HR=0.47, p=0.366; PFS: HR=0.70, p=0.581), favoring R-CHOP.

Conclusions

Our study demonstrates the inadequacy of R-CHOP(-like) regimens in contemporary DLBCL management and highlights the ongoing unmet need for improved therapeutic strategies.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Tanoto Foundation Professorship in Medical Oncology New Century Foundation Limited Ling Foundation Singapore Ministry of Health’s National Medical Research Council Research Transition Award (TA21jun-0005) and Large Collaborative Grant (OFLCG18May-0028).

Disclosure

All authors have declared no conflicts of interest.