Comparison between Pola-R-CHP and R-CHOP regimens in patients newly diagnosed with diffuse large B-cell lymphoma: a propensity score-matched study

Abstract

Abstract The POLARIX trial demonstrated progression-free survival (PFS) benefit with polatuzumab vedotin-based therapy (Pola-R-CHP) over R-CHOP in diffuse large B-cell lymphoma (DLBCL). However, real-world data are limited for populations underrepresented in POLARIX, including patients with limited-stage disease, low international prognostic index (IPI) risk, or aged ≥ 81 years. We compared Pola-R-CHP and R-CHOP efficacy using propensity score matching (82 pairs from 86 to 189 patients, respectively). Patients newly diagnosed with DLBCL treated with Pola-R-CHP showed trends toward improved 2-year PFS overall (75.5% vs. 61.4%, p  = 0.065), in limited-stage disease (96.0% vs. 73.8%, p  = 0.057), and in low- IPI risk (100% vs. 81.2%, p  = 0.11), with significant benefit in non-GCB subtype (76.3% vs. 51.0%, p  = 0.013) compared to those with R-CHOP. No difference was detected between patients treated with Pola-R-CHP and R-CHOP aged ≥ 81 years ( p  = 0.43). In patients treated with Pola-R-CHP, age ≥ 81 years was an independent adverse factor for overall survival (OS) (HR 5.44, 95% CI 1.05–32.26, p  = 0.044). This real-world study is consistent with POLARIX findings in non-GCB DLBCL and suggests potential benefits in limited-stage or low-IPI patients, though validation is needed. Results support Pola-R-CHP across diverse populations, with careful selection for treatment warranted in patients aged ≥ 81 years.