期刊
BLOOD ADVANCES
卷 5, 期 18, 页码 3528-3539出版社
ELSEVIER
DOI: 10.1182/bloodadvances.2021004865
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类别
资金
- Public Health Service from National Institutes of Health National Cancer Institute [U24CA076518]
- National Heart, Lung, and Blood Institute
- National Institute of Allergy and Infectious Diseases
- Health Resources and Services Administration [HHSH250201700006C, HHSH250201700007C]
- Office of Naval Research [N00014-20-1-2705, N00014-20-1-2832]
- National Institutes of Health National Institute of Allergy and Infectious Diseases [R01AI128775 U01AI126612]
- National Institutes of Health National Heart, Lung, and Blood Institute [R01HL130388]
- National Institutes of Health National Eye Institute [UG1HL06924]
- Biomedical Advanced Research and Development Authority
- Be the Match Foundation
- Boston Children's Hospital
- St. Baldrick's Foundation
- Stanford University
- Medical College of Wisconsin the National Marrow Donor Program
- Actinium Pharmaceuticals, Inc.
- Adienne SA
- AlloVir, Inc.
- Amgen, Inc.
- Angiocrine Bioscience
- Astellas Pharma US
- bluebird bio, Inc.
- Bristol Myers Squibb Co.
- Celgene Corp.
- CSL Behring
- CytoSen Therapeutics, Inc.
- Daiichi Sankyo Co., Ltd.
- ExCellThera
- Fate Therapeutics
- Gamida-Cell, Ltd.
- Genentech Inc.
- Incyte Corporation
- Janssen/Johnson Johnson
- Jazz Pharmaceuticals, Inc.
- Kiadis Pharma
- Kite, a Gilead Company
- Kyowa Kirin
- Legend Biotech
- Magenta Therapeutics
- Merck Sharp Dohme Corp.
- Millennium
- Miltenyi Biotec, Inc.
- Novartis Pharmaceuticals Corporation
- Omeros Corporation
- OncoImmune, Inc.
- Orca Biosystems, Inc.
- Pfizer, Inc.
- Pharmacyclics, LLC
- Sanofi Genzyme
- StemCyte
- Takeda Pharma
- Vor Biopharma
- Takeda Oncology Co.
- Xenikos BV
- National Institutes of Health National Cancer Institute [R01CA215134]
Hematopoietic cell transplantation (HCT), including autologous and allogeneic HCT, may lead to durable remissions in therapy-sensitive patients with Richter syndrome. Complete response was associated with better outcomes in the allo-HCT cohort, while cytogenetic abnormalities and prior novel therapy did not impact outcomes.
Richter syndrome (RS) represents a transformation from chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) to aggressive lymphoma, most commonly diffuse large B-cell lymphoma (DLBCL), which is associated with a dismal prognosis. Patients with DLBCL-RS have poor outcomes with DLBCL-directed therapy; thus, consolidation with hematopoietic cell transplantation (HCT) has been used, with durable remissions observed. Studies reporting HCT outcomes in patients with DLBCL-RS have been small, have not evaluated the prognostic impact of cytogenetic risk factors, and were conducted prior to the era of novel targeted therapy of CLL/SLL. We performed a Center for International Blood and Transplant Research registry study evaluating outcomes after autologous HCT (auto-HCT; n = 53) and allogeneic HCT (allo-HCT; n = 118) in patients with DLBCL-RS treated in the modern era. More auto-HCT recipients were in complete response (CR) at HCT relative to allo-HCT recipients (66% vs 34%), whereas a higher proportion of allo-HCT recipients had 17p deletion (33% vs 7%) and had previously received novel agents (39% vs 10%). In the auto-HCT cohort, the 3-year relapse incidence, progression-free survival (PFS), and overall survival (OS) were 37%, 48%, and 57%, respectively. Among allo-HCT recipients, the 3-year relapse incidence, PFS, and OS were 30%, 43%, and 52%, respectively. In the allo-HCT cohort, deeper response at HCT was associated with outcomes (3-year PFS/OS, 66%/77% CR vs 43%/57% partial response vs 5%/15% resistant; P < .0001 for both), whereas cytogenetic abnormalities and prior novel therapy did not impact outcomes. In our study, HCT resulted in durable remissions in therapy-sensitive patients with DLBCL-RS treated in the era of targeted CLL/SLL therapy, including patients with high-risk features.
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