Real-world use of polatuzumab vedotin combined with bendamustine and rituximab for patients with relapsed or refractory large B-cell lymphoma.

[BACKGROUND/AIMS] Polatuzumab vedotin combined with bendamustine and rituximab (Pola-BR) is a treatment option for relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL), particularly as bridging therapy before chimeric antigen receptor (CAR) T-cell infusion. However, real-world data regarding its feasibility, efficacy, and safety in Korean patients are limited.

[METHODS] We conducted a single-center retrospective study of 52 patients with R/R DLBCL treated with Pola-BR between April 2021 and April 2024. Patients were categorized into three groups: salvage (n = 26), post-CAR T (n = 13), and bridging (n = 13). The primary endpoints were objective response rate (ORR) and complete response (CR) rate; progression-free survival (PFS), overall survival (OS), and safety were secondary endpoints.

[RESULTS] The overall ORR was 51.9% (27/52), with 36.5% (19/52) of the patients achieving CR. The ORRs were 46.2%, 53.8%, and 61.5% in the salvage, post-CAR T, and bridging groups, respectively, with corresponding CR rates of 30.8%, 38.5%, and 46.2%. The bridging group achieved the highest response rates despite receiving a median of only one cycle, and patients with fewer prior treatment lines demonstrated superior responses. Grade 3-4 hematologic toxicities occurred in nearly all post-CAR T (100%) and salvage (92.3%) patients but were significantly lower in the bridging group (46.2%).

[CONCLUSION] Pola-BR provided meaningful disease control in patients with R/R DLBCL. Its use as a bridging therapy before CAR T-cell infusion was associated with high response rates, favorable safety, and a successful transition to cellular therapy, underscoring its value as a practical option in this setting.