Pola-R-CHP as frontline therapy for diffuse large B-cell lymphoma: a systematic review and meta-analysis of randomized trials and real-world evidence

Cancer research · Diffuse large B-cell lymphoma

Pola-R-CHP regimen is the new standard of care for untreated diffuse large B-cell lymphoma (DLBCL) patients, following the POLARIX trial.

Pola-R-CHP regimen is the new standard of care for untreated diffuse large B-cell lymphoma (DLBCL) patients, following the POLARIX trial. This study evaluates whether clinical trial (RCT) efficacy and safety are reproducible in real‑world evidence (RWE) settings. This systematic review and meta‑analysis compared outcomes between RCTs and RWE studies. Primary endpoints were complete response (CR) rate, progression‑free survival (PFS), and overall survival (OS). Meta‑regression explored heterogeneity using age, International Prognostic Index (IPI), and activated B‑cell‑like (ABC) subtype as moderators. Data from 2 RCTs and 10 RWE studies (3,472 patients) were integrated. The pooled CR rate was 78% (95% CI: 74–82%), with RWE studies showing a significantly higher CR (80%) than RCTs (69%, P < 0.001). The pooled 1‑year PFS was 85%, significantly higher in RWE (86%) than RCTs (81%, P = 0.02). Pooled 1‑year OS was 91%, with no significant difference between RWE (90%) and RCTs (94%, P = 0.35). Despite high heterogeneity (I² 74–91%), meta‑regression confirmed that age, IPI score, and ABC subtype did not significantly influence treatment effects, though trends for improved CR and PFS were noted. In conclusion, this meta‑analysis confirms that Pola‑R‑CHP outcomes in real‑world practice are consistent with, and occasionally exceed, those observed in clinical trials. Despite inherent heterogeneity in RWE, these findings support Pola‑R‑CHP as a robust frontline therapy for a broad DLBCL population, regardless of baseline clinical characteristics.

Demonstrating that Pola‑R‑CHP achieves comparable or superior outcomes in real‑world settings supports its broader adoption as frontline therapy for diffuse large B‑cell lymphoma.

Evidence level: Számítógépes vagy elméleti. Modellből vagy adatbányászatból származó jel.

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