Autologous Transplantation May Still Effectively Treat Relapsed Diffuse Large B-Cell Lymphoma in Selected Patients

Treating relapsed and refractory diffuse large B-cell lymphoma is still challenging for clinicians. CAR-T cell therapy changed the role of autologous stem cell transplantation in r/r DLBCL patients. The aim of our retrospective study was to assess our data to determine achievable results and to find any additional factors affecting the results of conventional autologous transplantation, determining possible ways to improve the outcome. In a population of 116 DLBCL patients, we found a 75-month median EFS and 105-month median OS. Prognostic markers existing at diagnosis (IPI, LDH, Ann Arbor, COO) lose their significance by the time of transplantation. Consolidative ASCT can be considered an effective and reasonable treatment option for eligible chemosensitive patients with DLBCL, and it still adds survival benefit for additional patients not reaching a complete response before transplantation. Abstract: Treating relapsed and refractory diffuse large B-cell lymphoma is still challenging for clinicians, but the available CAR-T and bispecific antibodies have revolutionized therapy. Autologous stem cell transplantation was the most effective treatment modality previously. The authors reported data from a single center over ten years. The retrospective study included 116 patients, with 53 relapsed cases, 39 primary refractory cases, 19 who had CNS involvement, and 5 who had received primary consolidation transplants. The median duration of follow-up was 46 months. The median event-free survival was 75 months, and the median overall survival was 105 months for all cases. Five-year overall survival was 59%, and event-free survival was 54%. Pretreatment prognostic factors at diagnosis had no effect on the outcome of transplantation. The authors found no difference between survival in relapsed or refractory cases, and the number of salvage lines or the germinal center/activated B-cell type also did not influence the results. Complete metabolic response before transplantation confirmed by (18)FDG PET/CT strongly affected survival. The pre-transplant creatinine and CRP levels significantly influenced the long-term outcome. The number of stem cells infused did not affect survival, but engraftment within nine days did result in a longer survival. These data support the finding that the response to salvage therapy did facilitate the identification of a better prognostic group who may still benefit from autologous transplantation.

Automated summary

Treating relapsed and refractory diffuse large B-cell lymphoma remains challenging. CAR-T cell therapy has changed the role of autologous stem cell transplantation in these patients. The aim of this retrospective study was to evaluate the results of autologous transplantation and identify factors affecting the outcomes. Among 116 DLBCL patients, the median event-free survival and overall survival were 75 months and 105 months, respectively. Prognostic markers at diagnosis had no impact on the transplantation outcome. Consolidative autologous transplantation is an effective treatment option for eligible patients with DLBCL and can benefit those not achieving complete response before transplantation.