Abstract
The relative efficacy of autologous hematopoietic cell transplant (auto-HCT) vs chimeric antigen receptor T-cell (CAR-T) therapy in patients with diffuse large B-cell lymphoma (DLBCL) 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 patients with DLBCL who received either an auto-HCT (2013-2019) or CAR-T treatment with axicabtagene ciloleucel (2018-2019) while in a PR by computed tomography or positron emission tomography scan. We compared the clinical outcomes between the 2 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 = .1) and the rate of 100-day nonrelapse mortality (4% vs 2%; P = .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 = .05) and a superior overall survival (OS) (69% vs 47%; P = .004) at 2 years. In the multivariable regression analysis, treatment with auto-HCT was associated with a significantly lower risk of relapse/progression rate (hazard ratio = 1.49; P = .01) and a superior OS (hazard ratio = 1.63; P = .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.
Original language | English (US) |
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Pages (from-to) | 1330-1339 |
Number of pages | 10 |
Journal | Blood |
Volume | 139 |
Issue number | 9 |
DOIs | |
State | Published - Mar 3 2022 |
Keywords
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Autografts
- Disease-Free Survival
- Female
- Hematopoietic Stem Cell Transplantation
- Humans
- Immunotherapy, Adoptive
- Lymphoma, Large B-Cell, Diffuse/mortality
- Male
- Middle Aged
- Recurrence
- Survival Rate
ASJC Scopus subject areas
- Hematology
- Biochemistry
- Cell Biology
- Immunology