Rituximab + chemotherapy (chemoimmunotherapy) is the standard of care in first-line (1L) treatment and leads to cure in approximately 60% of patients. A Phase III trial, POLARIX, reported that adding Polivy, an anti-CD79b antibody-drug conjugate, to rituximab + chemotherapy results in improved progression-free survival. POLARIX supported 1L supplementary approvals in the EU (May 2022), Japan (August 2022) and US (April 2023). The Polivy combination is set to become the new standard of care for 1L patients with higher-risk disease who can tolerate slightly more toxicity. 

Rituximab + platinum-based chemotherapy followed by consolidation with high-dose chemotherapy and autologous stem cell transplant (ASCT) is the historical standard treatment for transplant-eligible second-line (2L) patients. In 2022, Yescarta and Breyanzi both received US Food and Drug Administration approval for patients refractory to 1L chemoimmunotherapy or who relapse within 12 months of 1L chemoimmunotherapy. Breyanzi’s US approval also includes patients not eligible for transplant, regardless of time to relapse. Yescarta and Breyanzi are also approved in the EU and Japan for this 2L setting, and are expected to displace ASCT for 1L refractory patients or those who relapse within 12 months.