CAR T before the horse.
Two major trials were reported this week for B-cell lymphoma. BELINDA sought to move CAR T-cell therapy to the second line for DLBCL (CAR T is currently third line). Over 300 patients with refractory or relapsed aggressive lymphoma were randomized to tisagenlecleucel or salvage chemotherapy + autologous stem cell transplant. There was no difference in median event free survival (3 months for both groups), and 25.9% v 13.8% experienced progression after just 6 weeks. There was no difference in overall response rate (46% v 43%) or complete response rate (28% for both). POLARIX investigated the inclusion of polatuzumab vedotin, a CD79b antibody-drug conjugate, in standard first-line therapy for DLBCL. Nearly 900 patients with intermediate or high risk (IPI 2-5) DLBCL were randomized to standard R-CHOP or pola-R-CHP where polatuzumab replaced vincristine. Of note, consolidative radiation was allowed to sites of initially bulky or extranodal disease. At 2 years, pola-R-CHP significantly increased the rate of PFS compared to R-CHOP (76.7% v 70.2%). | Bishop, NEJM 2021 and Tilly, NEJM 2021