Outcome in patients with diffuse large B-cell lymphoma who relapse after autologous stem cell transplantation and receive active therapy. A retrospective analysis of the Lymphoma Working Party of the European Society for Blood and Marrow Transplantation (EBMT)

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Abstract

Autologous hematopoietic stem cell transplantation (auto-HSCT) is the standard of care for patients with diffuse large B-cell lymphoma (DLBCL) who relapse/progress after first line chemoimmunotherapy. Long-term outcome of those who relapse after transplant is poor. We present the results of a retrospective study of 256 adult patients reported to the EBMT registry with DLBCL who relapsed after auto-HSCT performed between 2003 and 2013, and who received active salvage strategies. One hundred and fifty-four (60%) were male; median age was 53 years. Median time to relapse was 7 months, 65% relapsed during the first year. Overall response rate after salvage therapy was 46%. Median follow-up after first salvage therapy was 40 months (IQR 23–63 months). Overall survival (OS) at 3 years was 27% (95% CI 22–33). OS at 3 years of patients relapsing longer than 1 year after auto-HSCT was 41% (95% CI 31–53) compared with 20% (95% CI 14–24) in those who relapsed in less than 1 year. Eighty-two patients (32%) had a second HSCT, an allogeneic HSCT (allo-HSCT) in 69 cases, at a median time of 6.5 months after relapse. OS at 3 years after allo-HSCT was 36% (95% CI 25–51). In conclusion, the prognosis of patients with DLBCL that relapse after auto-HSCT is dismal. Patients who relapse in less than 1 year remain an unmet need, and should be considered for CAR T cell therapy or clinical trials. Patients who relapse after 1 year can be rescued with salvage therapies and a second HSCT. These results provide a benchmark to compare data of new prospective studies.

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Acknowledgements

We acknowledge the kind support of all physicians and data managers of the participating transplantation centers.

Author information

E.G.-B. proposed the study, interpreted the data, and wrote the article. A.S. was the study coordinator, participated in the study design, interpreted the data, and edited the article. S.M. interpreted the data and edited the article. A.B. helped with the design and was responsible for statistical analysis. D.B., M.T., T.M., H.F., M.G.M., J.T.B., G.G., J.A.S, M.B., B.B., S.G.V., A.J., X.L., A.A., X.P., M.C., Z.N.Ö., E.V., M.I.-R., J.Y.C., E.J., W.S., J.M., A.E., P.D. reported updated patient data, and read and commented on the article. All the authors proofread the article and agreed on the data presented.

Correspondence to E. González-Barca.

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