Real-World Comparative Analysis of Polatuzumab Vedotin–Based Pola-R-CHP Versus Standard R-CHOP in Diffuse Large B-Cell Lymphoma: A Propensity Score–Matched Cohort Study

Introduction The regimen of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) remains the standard first-line treatment for diffuse large B-cell lymphoma (DLBCL), yet many patients relapse. Polatuzumab vedotin combined with rituximab, cyclophosphamide, doxorubicin, and prednisone (Pola-R-CHP) has shown promise in trials. This study investigates the real-world efficacy and safety of Pola-R-CHP versus R-CHOP. Methods We retrospectively analyzed 505 DLBCL patients treated at Peking Union Medical College Hospital between January 2011 and March 2025. Thirty-six patients received Pola-R-CHP; 36 matched R-CHOP patients were selected using 1:1 propensity score matching based on age, sex, subtype, stage, and IPI. Outcomes included interim and end-of-treatment response, overall survival (OS), progression-free survival (PFS), and adverse events (AEs). Results Post-matching, 72 patients were included. Pola-R-CHP achieved higher interim CR (72.2% vs. 63.9%, P = 0.035) and ORR (100.0% vs. 83.3%, P = 0.011). At the end of treatment, CR was further improved (88.9% vs. 63.9%, P = 0.007), and ORR remained superior (100.0% vs. 86.1%, P = 0.020). At a median follow-up of 13.3 months (range, 1.1–141.9 months), 1 death and 2 progressions occurred in the Pola-R-CHP group compared with 9 deaths and 9 progressions in the R-CHOP group. Median OS and PFS were not reached in either cohort. At 12 months, the estimated OS was 97% for Pola-R-CHP and 94% for R-CHOP (P = 0.825), while the estimated PFS was 86% and 94%, respectively. This represented a numerical but not statistically significant difference (P = 0.457), likely reflecting the immature survival data and limited number of events at the time of analysis, rather than a true efficacy difference. Neutropenia was the most frequent adverse event (69.4%) and showed comparable severity between groups, while grade ≥3 AEs were numerically less frequent with Pola-R-CHP (8.3% vs. 13.9%, P = 0.453). Conclusion Pola-R-CHP achieved higher interim and end-of-treatment response rates than R-CHOP with a comparable safety profile. However, survival outcomes remain immature, and given the small matched sample size (n = 72), these findings should be interpreted cautiously and confirmed in larger prospective studies.