Is Autologous Transplant In Relapsed DLBCL Patients Achieving Only A PET+ PR Appropriate In The CAR T-Cell Era?
In the March 11, 2021 edition of the Journal Blood, investigators reported on the utility of autologous hematopoietic stem cell transplantation in PET+ DLBCL. With the development of a variety of CAR-T therapies, the Center for International Blood and marrow transplant research reported an approximate 10% decrease in the number of autologous hematopoietic stem cell transplantation for diffuse large B-cell lymphoma in the United States.
Utilizing their database, investigators identified 249 relapsed diffuse large B-cell lymphoma patients undergoing autologous hematopoietic stem cell transplantation between the years 2003 and 2013, with a positive positron emission tomography computed tomography partial response prior to transplant. The study cohort was organized into 2 groups: Early chemotherapy–immunotherapy failure, ECF, defined as patients with primary refractory disease or relapse within 1 year of diagnosis and late chemotherapy–immunotherapy failure, defined as patients relapsing after 12 months. The primary outcome was overall survival. Secondary outcomes including progression free survival and relapse were assessed as well.
A total of 182 patients had early chemotherapy immunotherapy failure, while 67 did not. Among the first cohort, 79% had Primary refractory disease. The adjusted 5-year probabilities for progression free survival and overall survival between the 2 groups were not different, 41% versus 49%, P = 0.93 and 51% versus 63%, p= 0.09, respectively. Using a multivariate analysis, the investigators determined that early chemotherapy-immunotherapy failure patients have an increased risk for death, hazard ratio 1.61, 95% confidence interval 1.05–2.46, P = 0.03 but not for progression free survival or relapse.
The authors concluded ” for relapsed chemosensitive diffuse large B-cell lymphoma patients, with residual PET/CT positive disease prior to autologous hematopoietic stem cell transplantation, the adjusted 5-year progression free survival, 41%, was comparable, irrespective of time to relapse. These data support ongoing application of autologous hematopoietic stem cell transplantation in chemosensitive diffuse large B-cell lymphoma”