Polatuzumab vedotin (pola) may be an effective for patients with relapsed/refractory large B-cell lymphoma (r/r LBCL) as a bridging therapy to chimeric antigen receptor (CAR) T-cell therapy, according to research in Blood Advances.
Patients with LBCL who are ineligible or did not respond to autologous stem cell transplantation (autoHCT) have poor outcomes from the disease. CAR-T cell therapy is promising for patients with r/r LBCL, but many patients progress before they can receive treatment.
Pola is an antibody-drug conjugate that may be an effective bridging therapy. The study authors retrospectively analyzed real-world data from 105 patients with r/r LBCL who received pola under the German compassionate use program either as salvage therapy or bridging therapy.
Most patients were heavily pretreated with a median of 3 prior treatment lines. Patients in the bridging therapy cohort were younger than patients in the salvage cohort.
A total of 54 patients received pola as salvage therapy with 59.3% treated with pola plus bendamustine and rituximab (pola-BR) or an alternate chemotherapy regimen with pola. The overall response (OR) rate of patients in the salvage cohort was 48.1%. Patients who received pola plus chemotherapy had an OR of 52.9%, which was higher than the OR for patients who received pola with rituximab (40%; P =.4).
The 6-month overall survival (OS) was 49.6%, and the 12-month OS was 12.6% for patients in the salvage cohort. The median OS was 5.4 months.
51 patients received it as bridging treatment to CAR T-cell therapy or allogeneic HCT. 56.9% received pola plus chemotherapy, and 43.1% received pola plus rituximab (n=19) or pola monotherapy (n=3).
A total of 68.3% (28/41) of patients intended for CAR T-cell therapy successfully reached CAR T-cell treatment. Patients who received CAR T-cell therapy after pola had a 6-month OS of 77.9% and a 12-month OS of 58.5%.
There were 10 patients in the bridging cohort who were intended for allogeneic HCT (allo-HCT), and 5 were successfully bridged after pola therapy. The OS of the entire bridging cohort from study entry was 61.8%.
A total of 57 patients in the study died during follow up, most commonly from disease progression. Pola had a moderate toxicity profile in the study.
Overall, the real-world results demonstrate that pola may be an effective therapy to bridge patients to CAR-T therapy or to allo-HCT even for patients who have failed CAR T-cell treatment.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Liebers N, Duell J, Fitzgerald D, et al. Polatuzumab vedotin as a salvage and bridging treatment in relapsed or refractory large B-cell lymphomas. Blood Adv. 2021;5(13):2707-2716. doi:10.1182/bloodadvances.2020004155