Outcomes of Relapsed or Refractory Diffuse Large B-Cell Lymphoma Treated With R-GemOx: A Multicenter Cohort Study.

in American journal of hematology by Samuel Yamshon, Jean L Koff, Melissa C Larson, Brad S Kahl, Carla Casulo, Izidore S Lossos, Sara Haddadi, Michele Stanchina, Dai Chihara, Amy Ayers, Thomas M Habermann, Yucai Wang, Arushi Khurana, Grzegorz S Nowakowski, Tanner W Reicks, Umar Farooq, Brian K Link, Jonathon B Cohen, Peter Martin, Jia Li, Ashwini Shewade, Connie Lee Batlevi, Andrea Lo-Rossi, David Fox, Anthony Masaquel, Yong Mun, James R Cerhan, Christopher R Flowers, Matthew J Maurer, Loretta J Nastoupil

TLDR

  • A retrospective study of 183 patients with relapsed or refractory diffuse large B-cell lymphoma treated with Rituximab, Gemcitabine, and Oxaliplatin found an overall response rate of 45%, with varying outcomes depending on patient subgroup and treatment intent.

Abstract

Rituximab, gemcitabine, and oxaliplatin (R-GemOx) is a commonly used chemoimmunotherapy regimen for relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL), but there are limited real-world data. In a multicenter retrospective study from a cohort of eight US academic centers (LEO CReWE), we evaluated 183 patients with R/R DLBCL and high-grade B cell lymphoma treated with R-GemOx, including subgroups treated without intent for consolidation with autologous stem cell transplant (ASCT) or chimeric antigen receptor (CAR) T cell therapy (n = 100), those utilizing R-GemOx as a bridge to ASCT or CAR T (n = 83), and those aged 70 and older (n = 71). Overall response rates (ORRs) for all patients treated with R-GemOx were 45% with a complete response (CR) rate of 29%. The median event-free survival (EFS) was 2.3 months, and the median overall survival (OS) was 13.5 months. Patients receiving R-GemOx without intent for ASCT or CAR T had ORR and CR rates of 33% and 18%, respectively, with median EFS and OS of 2.0 and 9.5 months, respectively. Patients receiving R-GemOx as a bridge to ASCT or CAR T had ORR and CR rates of 57% and 36%, respectively, with median EFS and OS of 3.5 and 17.4 months, respectively. Patients receiving R-GemOx aged 70 and older had ORR and CR rates of 53% and 33%, respectively, with median EFS and OS of 2.2 and 13.9 months, respectively. These data provide a benchmark for R-GemOx in the rapidly evolving landscape of R/R DLBCL therapies.

Overview

  • The study evaluates the effectiveness of Rituximab, Gemcitabine, and Oxaliplatin (R-GemOx) in relapsed or refractory diffuse large B-cell lymphoma (DLBCL) patients across eight US academic centers.
  • The study analyzed 183 patients with R/R DLBCL and high-grade B cell lymphoma, including subgroups of patients who did not receive autologous stem cell transplant (ASCT) or chimeric antigen receptor (CAR) T cell therapy.
  • The primary objective of the study is to provide real-world data on the effectiveness of R-GemOx in R/R DLBCL patients, specifically focusing on patients who did not receive ASCT or CAR T therapy.

Comparative Analysis & Findings

  • The overall response rate (ORR) for all patients treated with R-GemOx was 45%, with a complete response (CR) rate of 29%, and median event-free survival (EFS) and overall survival (OS) of 2.3 months and 13.5 months, respectively.
  • Patients receiving R-GemOx without intent for ASCT or CAR T had lower ORR and CR rates compared to those receiving R-GemOx as a bridge to ASCT or CAR T, with median EFS and OS of 2.0 and 9.5 months, respectively.
  • Older patients (aged 70 and older) who received R-GemOx had a median EFS and OS of 2.2 and 13.9 months, respectively, similar to the overall patient population.

Implications and Future Directions

  • These data provide a benchmark for R-GemOx in the rapidly evolving landscape of R/R DLBCL therapies, highlighting the need for further research to optimize treatment choices for patients with R/R DLBCL.
  • The findings suggest that R-GemOx may be effective in certain patient subgroups, such as those aged 70 and older, who may not receive ASCT or CAR T therapy.
  • Future studies could investigate the use of R-GemOx in combination with other therapies, such as targeted agents or immunotherapy, to improve patient outcomes.
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