Current treatment options and considerations for patients with relapsed/refractory diffuse large B cell lymphoma in North Macedonia

Abstract

Autologous stem cell transplantation (ASCT) is considered standard therapeutic approach for patients with relapsed and refractory (R/R) diffuse large B cell lymphoma (DLBCL) that are transplant eligible. For transplant ineligible patients there are few therapeutic options and novel targeted therapies and immunotherapy that are still in development. Treatment of such patients with poor prognosis is considered to be a challenge and there is constant need for new salvage treatment regimens. The aim of this study was to evaluate patients’ characteristics and treatment strategies and considerations for diffuse large B cell lymphoma in our department, and to promote new therapeutic possibilities for R/R patients with NHL DLBCL. A total of 308 patients with NHL were treated at University Clinic for hematology from 2008 until 2020 and 49% (151) of patients with NHL DLBCL were included in this study. Survival analysis of all analyzed relapsed/refractory NHL patients revealed statistically significant better survival in patients with low risk IPI score, disease stage I/II and patients with age <60 years. R CHOP was superior treatment as first line regimen and in the R/R patients, ASCT was statistically superior to other available second line treatment options. Overall survival in patients with DLBCL that achieved complete response after initial treatment was 80%. The incidence of disease relapse after initial treatment in the first 12 months was 18%. Overall survival in all treatment groups was 60% in the evaluated period of 2.5 years follow up. A total of 60% of patients with relapsed forms of NHL DLBCL were candidates for treatment with high-dose chemotherapy and ASCT. Other 40% patients were not candidates for ASCT. In conclusion we confirm the need for new treatment options for patients that relapse after ASCT and that are transplant ineligible. Patients and disease characteristics can be used to identify high-risk patients, classify once relapsed patients and define decision on further treatment