Real-world efficacy of Bruton tyrosine kinase inhibitor based maintenance therapy in diffuse large B-cell lymphoma: a multicenter retrospective cohort study with external historical control.

[INTRODUCTION] The selection of an optimal maintenance agent in diffuse large B-cell lymphoma (DLBCL) continues to pose a significant clinical challenge. This study aims to evaluate the prognostic impact of maintenance therapy (MT) in DLBCL.

[METHODS] We conducted a retrospective analysis of data from DLBCL patients undergoing first-line MT at four hospitals in Beijing between January 2019 and August 2024. The REMoDL-B trial database was selected as the control group.

[RESULTS] The MT group comprised 106 cases and a median follow-up duration of 25.4 months. The rates of progression and death were 11.32% (12/106) and 1.89% (2/106), respectively. The 2-y progression-free survival (PFS) and overall survival (OS) rates were 90% and 98%, respectively. The MT group demonstrated significantly superior PFS and OS compared to the control group ( = 0.024,  = 0.008). Furthermore, multivariate analysis indicated that MT ( = 0.021, OR = 0.037, 95% CI, 0.002-0.605) was an independent prognostic factor associated with improved PFS. For patients receiving Bruton tyrosine kinase inhibitors (BTKi), the 2-y PFS and OS rates were 87.6% and 97.2%, respectively, both significantly better than those of the control group ( = 0.048,  = 0.024). Despite 43.6% of patients being at high risk for central nervous system (CNS), no CNS recurrences were observed. The PFS of the MCD subtype is better than that of the A53 subtype.

[CONCLUSIONS] While limited by the retrospective study, our analysis raises the hypothesis that MT may correlate with improved DLBCL outcomes. A similar trend suggesting potential benefit from BTKi maintenance was noted, meriting further investigation in controlled settings.