Is Autologous Transplant in Relapsed DLBCL Patients Achieving Only a PET+ PR Appropriate in the CAR-T cell Era?

For relapsed, chemosensitive diffuse large B-cell lymphoma (DLBCL) consolidation with autologous hematopoietic cell transplantation (auto-HCT) is a standard option. Since the approval of anti-CD19 CAR T-cells in 2017, the Center for International Blood and Marrow Transplant Research (CIBMTR) reported a 45% decrease in the number of auto-HCT for DLBCL in the U.S. in 2018. Using the CIBMTR database, we report outcomes for auto-HCT in relapsed chemosensitive DLBCL in a partial response (PR). 249 relapsed DLBCL patients undergoing auto-HCT from 2003-13 with a PET/CT+ PR prior to transplant were identified. The study cohort was divided into two groups: (a) early chemo-immunotherapy failure (ECF) defined as patients with primary refractory disease (PRefD) or relapse within 12 months of diagnosis, (b) late chemoimmunotherapy failure defined as patients relapsing ≥12 months. Primary outcome was overall survival (OS). Secondary outcomes included progression-free survival (PFS) and relapse. 182 patients had ECF and 67 were no ECF. ECF patients were younger (57 versus (vs) 63 years, p<0.01) and 79% of had PRefD. The adjusted 5-year probabilities for PFS and OS (ECF vs no ECF) was not different: 41% vs 41% (p=0.93) and 51% vs 63% (p=0.09), respectively. On multivariate analysis, ECF patients had increased risk of death (HR=1.61, 95%CI 1.05-2.46, p=0.03) but no increased risk in PFS or relapse. In conclusion, for relapsed, chemosensitive DLBCL patients with residual PET/CT+ disease prior to auto-HCT, the adjusted 5-year PFS (41%) was comparable irrespective of time to relapse. These data support ongoing application of auto-HCT in chemosensitive DLBCL.

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