Study to Evaluate the Effectiveness of Tafasitamab in Combination With Lenalidomide Followed by Tafasitamab Monotherapy in Relapsed or Refractory Diffuse Large B-cell Lymphoma Non-transplant Eligible Patients in Italy (PRO-MIND)

This is an Italian, multicenter, prospective observational cohort study to collect data on patients with non-transplant eligible R/R DLBCL treated with tafasitamab plus lenalidomide followed by tafasitamab in monotherapy, as second, third and fourth treatment line in a real-world clinical practice setting.

The study is non-interventional; all treatment decisions are made at the discretion of the patient's healthcare provider and are not mandated by the study design or protocol.

Since this is an observational study of real-world treatment practices and outcomes, no study medication will be provided as a part of this study. Tafasitamab and lenalidomide will be provided through usual commercial channels for medicines prescription. Tafasitamab and lenalidomide will not be provided free of charge by the sponsor.

Physicians will make all treatment decisions according to their usual clinical practices and will provide prescriptions for their patients as appropriate. The decision to treat the patient with tafasitamab must have been taken prior to and independently of the patient's inclusion in the study. There are no mandatory protocol procedures or diagnostic tests.

This is a prospective observational study: patients will be eligible to enter the study if the treatment with tafasitmab plus lenalidomide is started and when all the ethical and contract procedures with the site have been completed and after the site initiation visit date.

The study will be performed in approximately 30 Italian sites distributed in the overall Italian territory.

During this study, patients must completed questionnaires of quality of life. Questionnaires should be completed by the patient Electronic Patient Reported Outcome (ePRO)at each applicable occasion. Where possible in accordance with local clinical practice, PROs should be completed before other assessments. The following measures are requested to be recorded:

• EORTC-QLQ-C30 (Version 3).
• EORTC QLQ NHL-HG29

The standardized EORTC QLQ-C30 questionnaire (v. 3.0) was used to assess the HRQoL of cancer patients. The questionnaire contains questions regarding the impact of the disease on different areas of a patient's life (physical, role, emotional, cognitive, and social functioning), the occurrence of symptoms (fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, constipation, and diarrhea), financial difficulties, and an overall assessment of HRQoL (Appendix 4). (Aaronson NK, Ahmedzai S, Bergman B, et al. 1993). For each question, the respondent must choose 1 answer. For 28 of the questions, the answers are given on a 4-point Likert-type scale (1 - never, 2 - sometimes, 3 - often, 4 - very often) and assess the intensity of the analysed parameters. The last 2 questions evaluate the general health of the patient on a 7-point scale (from 1 - very bad to 7 - excellent). Patients completed the questionnaires by themselves. If a question arose, they could ask the researcher for an explanation.

After collecting the responses, a raw score was calculated for each of the abovementioned 15 questionnaire items. Next, a linear transformation was performed to obtain a score in a range from 0 to 100. The conversion of the results to a 100-point scale was made according to the EORTC guidelines. Of note, a higher score on the functional scales means better functioning and a higher response for general health corresponds to a better HRQoL.

The QLQ-HG-NHL29 consists of 29 items, contributing to five multiitem subscales and three conditional items: symptom burden due to disease and/or treatment (seven items), neuropathy (two items), physical condition/fatigue (five items), emotional impacts (four items) and worries about health and functioning (eight items). The three conditional items, which patients complete only if relevant to them, are about having problems at work/education, worries about work/education and concerns about the ability to have children. (Appendix 5) (Van de Poll-Franse L, Oerlemans S, Bredart A, et al. 2018) Items are rated using a four-point response scale ("not at all," "a little," "quite a bit," and "very much") and the reference time frame for all items is the past week.14 The scoring approach for the QLQ-HG-NHL29 is identical to that of the EORTC QLQ-C30, i.e., calculating the mean of the items of a specific multi-item scale or using the single conditional item score and then converting it into a standardized scale ranging from 0 to 100. A higher score for all the multi-item scales and items represent a higher level of symptomatology or problems.

HRQoL questionnaires will be filled out either at the hospital or during pre-scheduled medical office visits. The questionnaires will be provided to the patient by a member of the study team at the scheduled times to coincide with other scheduled assessments or visits, via standard paper copy administration. However, HRQoL electronic questionnaires administration may be allowed as a back-up procedure, to maximize compliance. Patients will be asked to fill out the questionnaires as completely and accurately as possible with an expected average time of completion around 10 minutes.

A high compliance with HRQoL questionnaires throughout the study period is considered essential for the success of this observational study and local Investigators of participating centers will have to be properly informed and motivated towards the importance of collecting HRQoL data.

Each participating center will be requested to submit a HRQoL Missing Data Form in lieu of a HRQoL questionnaire for any assessment that is not provided at the appropriate follow-up time point. Compliance with HRQoL questionnaires over time will be monitored (not for the purpose of informing clinical care of participants) and, if needed, reminders will be sent to participating centers to solicit HRQoL data. The compliance rate at each time point will be evaluated as the number of valid HRQoL questionnaires returned by eligible patients as a proportion of the total number of eligible patients available.

In order to make the HRQoL component of the study as pragmatic as possible, and not to undermine the data collection process across several centers, HRQoL assessment is requested to take place in conjunction with the collection of effectiveness data foreseen for this protocol.

Therefore, HRQoL questionnaires will be administered at baseline (before first tafasitamab administration) and then every 3 months during the first year, and then every 6 months thereafter, unless the patient has a disease progression and/or permanently discontinue treatment with tafasitamab. The first HRQoL assessment after baseline, would correspond to the end of the period where tafasitamab is administered on a weekly basis (approximately at the end of cycle 3), hence with potential expected HRQoL detriments. Thereafter, (starting from cycle 4) considering the infusions of tafasitamab will take place every 2 weeks, HRQoL improvements (although with not known magnitude) could possibly be expected and captured in this study. HRQoL will be assessed regardless of dose modification or temporary treatment interruption, as long as the patient is considered "on study" according current protocol definition.

In case of temporary treatment interruption:

Continue HRQoL assessment as described in the above schedule of administration.

In case of permanent treatment discontinuation with tafasitamab:

HRQoL assessment should be performed at the time of discontinuation (in any case as close as possible to the time of treatment discontinuation) and then stopped afterwards.

In case of disease progression:

HRQoL assessment should be performed at the time of progression (in any case as close as possible to the time of disease progression) and then stopped afterwards.

Inclusion criteria

• Patients are aged 18 years or older.
• Patients with DLBCL R/R disease non-transplant eligible.
• Patients who will initiate the treatment with commercially available tafasitamab and lenalidomide after the ICF signature. The decision to prescribe tafasitamab must have been made prior and regardless of the enrollment of the patient in the study.
• Patients are able of giving the signed informed consent.

Exclusion criteria

• Concomitant participation in an interventional clinical study
• Any patient in the physician's opinion from whom initial diagnosis or follow-up data is unlikely to be obtained reliably data for the purposes of this observational study.
• Patients who started tafasitamab treatment before signing the ICF.