# Management of Canadian patients with refractory or relapsed diffuse large B-cell lymphoma in the real world: a subanalysis of the RE-MIND2 study

## TL;DR

This study examines treatment patterns for Canadian patients with relapsed or refractory diffuse large B-cell lymphoma, highlighting limited access to CAR-T therapy and poor outcomes for those ineligible for stem cell transplants.

## Contribution

The study provides real-world insights into treatment patterns and outcomes for Canadian R/R DLBCL patients, emphasizing the need for novel therapies for ASCT-ineligible patients.

## Key findings

- Only 45.4% of ASCT-eligible patients received transplants in second-line therapy.
- CAR-T therapy became available in later lines of treatment by the end of 2019.
- Patients ineligible for ASCT had poor prognosis with conventional salvage chemotherapy.

## Abstract

In the current Canadian treatment landscape for relapsed or refractory diffuse large B-cell lymphoma (R/R DLBCL), eligibility for autologous stem cell transplantation (ASCT) guides the choice of salvage treatment. CD19 chimeric antigen receptor T-cell (CAR-T) therapies have improved outcomes in patients with chemorefractory DLBCL, but access is limited to eligible patients. This subanalysis of the RE-MIND2 observational retrospective cohort study investigated treatment patterns for R/R DLBCL in Canada.

Data from patients enrolled in RE-MIND2 treated between 2010 and 2020 at 2 Canadian centers were retrospectively collected from health records. Descriptive statistics were used to analyze baseline characteristics, treatment initiated, and duration of treatment by line of therapy.

One hundred and nine patients were included; 74.2% of patients were eligible for ASCT as 2L therapy, and 45.4% received transplants. ASCT eligibility for third- (3L) and fourth-line (4L) therapy declined to 17.1% and 5.9%, respectively. Patients received a wide variety of treatments in 3 and 4L. CAR-T therapy became available in 3 and 4L by the end of 2019. Median durations of treatment were <2.6 months in all lines of therapy; median time to next treatment ranged from 3.4 months in 4L to 5.3 months in 2L.

Results of our study support that ASCT-ineligible patients have a poor prognosis with conventional salvage chemotherapy. Before the availability of novel immunotherapies, no apparent standard of care was observed for Canadian patients with R/R DLBCL who were ineligible for or did not receive ASCT, especially after 2L treatment.