Autologous transplant vs chimeric antigen receptor T-cell therapy for relapsed DLBCL in partial remission

Abstract

The relative efficacy of autologous hematopoietic cell transplant (auto-HCT) versus chimeric antigen receptor T-cell (CAR-T) therapy in diffuse large B-cell lymphoma (DLBCL) patients who achieve a partial remission (PR) after salvage chemotherapy is not known. Using the Center for International Blood & Marrow Transplant Research registry database, we identified adult DLBCL patients who received either an auto-HCT (2013-2019) or CAR-T treatment with axicabtagene ciloleucel (2018-2019) while in a PR by CT or PET scan. We compared the clinical outcomes between the two cohorts using univariable and multivariable regression models after adjustment for relevant baseline and clinical factors. In the univariable analysis, the 2-year progression-free survival (52% vs. 42% ; p=0.1) and the rate of 100-day non-relapse mortality (4% vs. 2% ; p=0.3) were not different between the 2 cohorts but consolidation with auto-HCT was associated with a lower rate of relapse/progression (40% vs. 53% ; p=0.05) and a superior overall survival (OS) (69% vs. 47% ; p=0.004) at 2-years. In the multivariable regression analysis, treatment with auto-HCT was associated with a significantly lower risk of relapse/progression rate (HR=1.49; p=0.01) and a superior OS (HR=1.63; p=0.008). In patients with DLBCL in a PR after salvage therapy, treatment with auto-HCT was associated with a lower incidence of relapse and a superior OS compared with CAR-T. These data support the role of auto-HCT as the standard-of-care in transplant-eligible patients with relapsed DLBCL in PR after salvage therapy.

Positron emission tomography derived metrics in relapsed or refractory large B‐cell lymphoma with residual disease before autologous stem cell transplant

“…22,23 Prior studies have not comprehensively analysed PET-derived metrics from patients with rrLBCL before ASCT. [9][10][11]17 We hypothesised that the pre-ASCT PET scan could be used to prognosticate outcomes for patients with rrLBCL and residual disease after salvage chemotherapy. We performed a single-centre retrospective analysis of patients with a disease response of PR or stable disease (SD) on PET scan after salvage chemotherapy who subsequently received ASCT consolidation, with a focus on qualitative and quantitative PET-derived metrics.…”

Autologous stem-cell transplantation as consolidation of first-line chemotherapy in patients with peripheral T-cell lymphoma: a multicenter GELTAMO/FIL study

“…Our results indicate that a significant proportion of patients in PR could benefit from transplantation, although, once again, these results must be interpreted with caution due to the very small sample size investigated in this subanalysis. Recent studies 16,17 have shown that patients with relapsed or refractory diffuse large B-cell lymphoma in PR after salvage therapy could still benefit from ASCT, but, to our knowledge, this subject has not been specifically investigated in patients with PTCL; it warrants being addressed in future studies. In all the studies that we have discussed, including our own, the response to induction therapy is assessed mainly by computed tomography.…”

Evidence-based expert consensus on the management of primary central nervous system lymphoma in China

“…Chimeric antigen receptor (CAR)-T cells as a "living drug" are able to penetrate BBB [122] and have been successfully used in treating R/R DLBCL [123,124]. The application of CAR-T cells in PCNSL remained debating because infusion of CAR-T cells may cause severe neurotoxicity, which is resulted from intracranial monocyte/ macrophage-mediated cytokine release and off-tumor targeted BBB damage [125,126].…”