689 | HOW TO OPTIMIZE THE USE OF HIGH‐COST THERAPIES IN DLBCL: A COLLABORATIVE OBSERVATIONAL STUDY BY THE URUGUAYAN LYMPHOMA GROUP
Introduction: DLBCL has heterogeneous clinical outcomes, and prognosis depends on patient´s and biological variables. Nevertheless, treatment for the last decades has relied on RCHOP schema for all patients fit for it. Results of the POLARIX study have challenged the paradigm of RCHOP treatment for every patient showing increased Progression Free Survival (PFS) in the experimental arm. Due to the high cost of Polatuzumab, there has been a great effort to identify patients most likely to benefit from this approach. Activated-B cell derived DLBCL, elderly and high risk patients by IPI seemin the study cohort to benefit the most. In limited resource countries, a careful selection of patients in whom to invest on more expensive therapies is extremely important. Furthermore, availability of effective second line treatment for the30% of patients expected to relapse are scarce, making this selection even more important. Objectives: Analyze the clinical characteristics and outcomes of patients with DLBCL treated in our country, trying to identify those who have the worst outcomes with conventional treatments and should be considered for novel therapies. Methods: Retrospective, observational study of patients with confirmed diagnosis of DLBCL treated with RCHOPor R-miniCHOP form 8 public and private institutions in Montevideo-Uruguay from 2008 to 2024. Primary mediastinal, primary SNC lymphoma and transformed DLBCL were excluded. COO was evaluated by Hans algorithm due to lack of access to GEP. Results: 294 patients included, 71.4% from private centers, 51.4% female. Median age 68 (19–90) 191 (65%) IPI 0–2, 103 (35%) 3–5. By Hans algorithm 44.2% GCB, 37.1% nonGCB, 18.7% unclassified. 91% received RCHOP, 9% RminiCHOP. Median of 6 cycles (0–7) CR achieved in 71%. 99 (33.7%) relapsed/refractory (R/R). Median follow up was 28.3 months (0.39–178) PFS and OS at 5 years were 48% and 58% respectively with a significant difference in IPI 0–2 versus 3–5 (59% vs. 29%) at 5 years for PFS p < 0.001 and 73% versus 23% for OS p < 0.001. In patients > 60 with IPI 3–5 OS at 5 years was 20% No difference in OS or PFS observed according to COO by IHQAmong R/R, OS at 5 years 23%. 25% received autoSCT. Conclusions: Our data show that with conventional RCHOP, the subset of patients with IPI 3–5 irrespective of stage or age alone have a dismal prognosis with a significantly shorter PFS and OS compared to IPI0–2, worse than what has been reported in international studies. COO did not correlate with outcomes which we attribute to quality of the reported IHQ. RR patients in our country have limited effective therapies available, mostly platinum-based chemotherapy and autoSCT in fit patients and very recently PolaBR in unfit patients. Lack of access to new agents like CART or bispecific antibodies in 2L compels us to make the most out of 1L therapy specially for those with the worst reported outcomes (IPI 3–5) in whom more expensive and effective therapies is justified. Research funding declaration: none Keywords: other; aggressive B-cell non-Hodgkin lymphoma; cancer health disparities No potential sources of conflict of interest.
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