Polatuzumab vedotin is a novel immunotherapy antibody–drug conjugate targeting CD79b. It has been used in relapsed/refractory (R/R) large B-cell lymphomas since its FDA approval in 2019. Presently, this drug is unaffordable or unavailable for patients in Lower–Middle Income Countries (LMIC) like India. This is a retrospective study of adult (> 18 years) patients with R/R large B-cell lymphoma failing two prior lines of therapy, who received Polatuzumab based salvage therapy on a compassionate or named-patient access program. Between May 2019 and April 2022, 10 patients received Polatuzumab vedotin, and 9 were evaluable. The most common regimen used was Polatuzumab-Bendamustine-Rituximab. Out of 43 infusions administered, the adverse event profile was manageable [One grade-2 infusion reaction, 4 patients developed grade 3–4 hematological toxicity and none had grade 3–4 non-hematological toxicities]. Ten infusions were administered in the day care service. After a median of 4.5 cycles (range 1–8), 4 patients achieved CR, 2 had partial response (PR), and 3 had progressive disease (PD). With a median follow up of 491 days (range 8–1048 days), four patients are alive (three in CR and one in PR), three patients have died and three patients were lost to follow up. Early real-world experience from a LMIC setting demonstrates feasibility and a favourable safety profile of Polatuzumab vedotin based approach, along with encouraging response rates in a subset of patients.
We report a case of stage IV primary mediastinal B-cell lymphoma in a 27-year-old young woman, who was refractory and chemoresistant to frontline conventional rituximab-based intensive chemotherapy and subsequent lines of conventional and immune checkpoint inhibitor-based therapies. She was successfully treated using a polatuzumab-based regimen and consolidated with an allogeneic haploidentical hematopoietic stem cell transplantation. She developed post-transplant large granular lymphocytosis that was managed conservatively. She is now relapse-free, 600 days post-transplant. The management of this patient provided several teaching points in the use of different modalities of immunotherapies in a hard-to-treat cancer and its related conditions.
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