Outcome in patients with diffuse large B-cell lymphoma who relapse after autologous stem cell transplantation and receive active therapy. A retrospective analysis of the Lymphoma Working Party of the European Society for Blood and Marrow Transplantation (EBMT)

E, González-Barca; A, Boumendil; D, Blaise; M, Trněný; T, Masszi; H, Finel; MG, Michieli; JT, Bittenbring; G, Gritti; JA, Snowden; M, Bishton; B, Bruno; A, Sureda

Abstract

Autologous hematopoietic stem cell transplantation (auto-HSCT) is the standard of care for patients with diffuse large B-cell lymphoma (DLBCL) who relapse/progress after first line chemoimmunotherapy. Long-term outcome of those who relapse after transplant is poor. We present the results of a retrospective study of 256 adult patients reported to the EBMT registry with DLBCL who relapsed after auto-HSCT performed between 2003 and 2013, and who received active salvage strategies. One hundred and fifty-four (60%) were male; median age was 53 years. Median time to relapse was 7 months, 65% relapsed during the first year. Overall response rate after salvage therapy was 46%. Median follow-up after first salvage therapy was 40 months (IQR 23–63 months). Overall survival (OS) at 3 years was 27% (95% CI 22–33). OS at 3 years of patients relapsing longer than 1 year after auto-HSCT was 41% (95% CI 31–53) compared with 20% (95% CI 14–24) in those who relapsed in less than 1 year. Eighty-two patients (32%) had a second HSCT, an allogeneic HSCT (allo-HSCT) in 69 cases, at a median time of 6.5 months after relapse. OS at 3 years after allo-HSCT was 36% (95% CI 25–51). In conclusion, the prognosis of patients with DLBCL that relapse after auto-HSCT is dismal. Patients who relapse in less than 1 year remain an unmet need, and should be considered for CAR T cell therapy or clinical trials. Patients who relapse after 1 year can be rescued with salvage therapies and a second HSCT. These results provide a benchmark to compare data of new prospective studies.

Citation

E, G.-B., A, B., D, B., M, T., T, M., H, F., …A, S. (2020). Outcome in patients with diffuse large B-cell lymphoma who relapse after autologous stem cell transplantation and receive active therapy. A retrospective analysis of the Lymphoma Working Party of the European Society for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplantation, 55(2), 393-399. https://doi.org/10.1038/s41409-019-0650-x

• Journal Article Type: Article
• Acceptance Date: Aug 9, 2019
• Online Publication Date: Sep 20, 2019
• Publication Date: 2020-02
• Deposit Date: Aug 1, 2023
• Journal: Bone Marrow Transplantation
• Print ISSN: 0268-3369
• Electronic ISSN: 1476-5365
• Publisher: Nature Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 55
• Issue: 2
• Pages: 393-399
• DOI: https://doi.org/10.1038/s41409-019-0650-x
• Public URL: https://nottingham-repository.worktribe.com/output/23550496
• Publisher URL: https://www.nature.com/articles/s41409-019-0650-x
• PMID: 31541205