Polatuzumab Vedotin: Current Role and Future Applications in the Treatment of Patients with Diffuse Large B-Cell Lymphoma
Rita Assi, Nohad Masri, Iman Abou Dalle, Jean El Cheikh, Hady Ghanem, Ali Bazarbachi
Abstract
Diffuse large B-cell lymphomas (DLBCL) constitute around 30% of all non-Hodgkin lymphomas (NHL) and account for the largest group of aggressive lymphomas DLBCL are further subdivided into three molecular subtypes by cell-of-origin (COO) portending prognostic and therapeutic implications: the germinal center B-cell phenotype (GCB), the activated peripheral B-cell subtype (ABC) and unclassifiable category The current standard of care frontline chemotherapy regimen includes the use of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), along with rituximab, a monoclonal antibody (MoAb) against the surface antigen CD20. Indeed, the advent of rituximab in the late 1990s, and its addition to CHOP (R-CHOP) [3] resulted in improved outcomes in all disease stages and settings with current 4-year overall survival (OS) ranging from 55% to 95% and a cure rate of around 60% Nevertheless, the clinical course can be life-threatening, with up to 40% of patients who can still relapse or have refractory disease, a scenario resulting in 5-year survival rates as low as approximately 25% for high-risk patients Subsequent outcomes differ greatly between patients depending on their transplant eligibility and response to second-line treatment. Multiple salvage regimens have been used, including dexamethasone, cytarabine and platinum, ifosfamide, carboplatin and etoposide or gemcitabine, dexamethasone and platinum (GDP), followed by autologous peripheral stem cell transplantation (APSCT), resulting in cure rates approaching 30-40%