First-line treatment with polatuzumab vedotin improves efficacy and survival in newly diagnosed patients with advanced diffuse large B-cell lymphoma: a multicentre retrospective analysis

Polatuzumab vedotin (Pola) is an anti-CD79b monoclonal antibody–drug conjugate that has shown remarkable efficacy and safety in diffuse large B-cell lymphoma (DLBCL) patients. Based on the results of the phase III POLARIX trial, it has been approved for first-line treatment of DLBCL. However, real-world studies are limited, particularly those assessing the efficacy differences between Pola-based regimens and traditional chemotherapy. This multicenter retrospective study analyzed clinical data from 64 newly diagnosed patients with advanced-stage, high-risk, or bulky DLBCL. Patients were categorized into the Pola plus chemotherapy (Pola) and traditional chemotherapy groups based on induction therapy. After excluding 6 patients who received fewer than four cycles of chemotherapy, 58 patients remained for efficacy analysis. The objective response rate after four cycles was 100% in the Pola group compared with 74.1% in the traditional chemotherapy group (<i>p</i> = 0.009). After a median follow-up of 13.5 months (range, 11.0–16.0 months), the median overall survival (OS), progression-free survival (PFS), and duration of response (DOR) in the Pola group were significantly longer than those in the traditional chemotherapy group (all <i>p</i> &lt; 0.05). Among patients with advanced disease, Pola plus chemotherapy was superior to traditional chemotherapy in terms of OS, PFS, and DOR (all <i>p</i> &lt; 0.05). For patients aged &gt;60 years with advanced disease, the Pola group had superior OS, PFS, and DOR (all <i>p</i> &lt; 0.05). Further subgroup survival analysis of patients receiving Pola-based therapy revealed that although the combination considerably improved PFS and DOR in advanced-stage patients, it did not overcome the poor prognosis associated with high P53 expression. Pola plus chemotherapy demonstrates superior efficacy and may prolong survival in patients with newly diagnosed advanced or high-risk DLBCL. However, it does not mitigate the unfavorable prognosis in patients with high P53 expression.