Journal article
Autologous stem cell transplant in fit patients with late relapsed diffuse large B-cell lymphoma that responded to salvage chemotherapy
Transplantation and cellular therapy, Vol.30(10), pp.1001.e1-1001.e12
07/10/2024
DOI: 10.1016/j.jtct.2024.07.008
PMID: 38996973
Abstract
•Patients with late relapsed DLBCL (≥12 months) who required more than 1 line of ST to achieve PR or CR had poor post-ASCT outcomes, and such patients should be treated with alternative therapies.•In contrast, patients who required only 1 line of ST had favorable post-ASCT outcomes supporting the current SOC in the second-line setting.•Post-ASCT outcomes appeared similar regardless of the age at ASCT, including those ≥70 years old, highlighting the safety and feasibility of this approach in older patients.
The standard of care (SOC) for fit patients with relapsed diffuse large B-cell lymphoma (DLBCL) ≥12 months after completing frontline therapy is salvage chemotherapy (ST) followed by autologous stem cell transplant (ASCT). However, this strategy may not be optimal for patients with certain clinical characteristics. We retrospectively studied 151 patients with DLBCL that relapsed ≥12 months after R-CHOP or R-CHOP-like frontline therapy who underwent ST and ASCT at Mayo Clinic between July 2000 and December 2017 or the University of Iowa between April 2003 and April 2020. Clinical characteristics, treatment information, and outcome data were abstracted. Progression-free survival (PFS) and overall survival (OS) from the time of ASCT were analyzed using the Kaplan-Meier method. The median time from frontline therapy completion to 1st relapse was 26.9 months. The median line of ST was 1 (range 1–3), and 17 (11%) patients required >1 line of ST. Best response before ASCT was partial response (PR) in 60 (40%) and complete response (CR) in 91 (60%) patients. The median age at ASCT was 64 years (range 19–78), and 36 (24%) patients were of ≥70 years. The median follow-up after ASCT was 87.3 months. The median PFS and OS were 54.5 and 88.9 months, respectively. There was no significant difference in PFS and OS based on the age at ASCT (including patients aged ≥70–78 years), sex, transplant era, time to relapse, LDH, extranodal site involvement, and central nervous system/nerve involvement at relapse. However, patients with advanced-stage relapse had inferior PFS than those with early-stage relapse (median 45.3 vs 124.7 months, P=0.045). Patients who required > 1 line of ST, compared to those requiring 1 line, had significantly inferior PFS (median 6.1 vs 61.4 months, P <0.0001) and OS (17.8 vs 111.7 months, P=0.0004). There was no statistically significant difference in survival in patients who achieved PR vs CR, though numerically inferior in the former, with median PFS of 38.9 vs 59.3 months (P=0.23) and median OS of 78.3 vs 111.7 months (P=0.62). Patients achieving CR after 1 line of ST had excellent post-ASCT outcomes, with median PFS of 63.7 months. In conclusion, survival after ASCT was unfavorable in patients with late relapsed DLBCL (≥12 months) who required more than 1 line of ST to achieve PR or CR, and such patients should be treated with alternative therapies. Conversely, survival was favorable in patients who required only 1 line of ST, supporting the current clinical practice of ASCT consolidation in these patients. Moreover, outcomes were favorable in patients aged ≥70–78 years at ASCT, similar to younger patients, highlighting the safety and feasibility of this approach in such patients.
Details
- Title: Subtitle
- Autologous stem cell transplant in fit patients with late relapsed diffuse large B-cell lymphoma that responded to salvage chemotherapy
- Creators
- Aung M. Tun - University of KansasYucai Wang - Mayo ClinicSeth Maliske - University of IowaIvana Micallef - Mayo ClinicDavid J. Inwards - Mayo ClinicThomas M. Habermann - Mayo ClinicLuis Porrata - Mayo ClinicJonas Paludo - Mayo ClinicJose Villasboas Bisneto - Mayo ClinicAllison Rosenthal - Mayo Clinic in ArizonaMohamed A Kharfan-Dabaja - Mayo Clinic in FloridaStephen M. Ansell - Mayo ClinicGrzegorz S. Nowakowski - Mayo ClinicUmar Farooq - University of IowaPatrick B. Johnston - Mayo Clinic
- Resource Type
- Journal article
- Publication Details
- Transplantation and cellular therapy, Vol.30(10), pp.1001.e1-1001.e12
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.jtct.2024.07.008
- PMID
- 38996973
- ISSN
- 2666-6367
- eISSN
- 2666-6367
- Grant note
The authors would like to acknowledge the staff of the CCaTS statistical consultation service at Mayo Clinic, for their assistance with statistical methods.
- Language
- English
- Electronic publication date
- 07/10/2024
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984656612902771
Metrics
12 Record Views