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Role of allogeneic hematopoietic cell transplant for relapsed/refractory aggressive B-cell lymphomas in the CART era


Anti-CD19 chimeric antigen receptor T cells (CART) has rapidly been adopted as the standard third-line therapy to treat aggressive B-cell lymphomas (ABCL) after failure of second-line therapy despite the lack of direct comparisons with allogeneic hematopoietic cell transplantation (alloHCT)-based strategies. Using the Grupo Español de Trasplante y Terapia Celular (GETH-TC) registry, we selected patients with the following characteristics: CART or alloHCT performed between 2016 and 2021; ≥18 years old; ABCL diagnosis; ≥2 lines of therapy; and either anti-CD19 CART or alloHCT as therapy at relapse. The analysis included a total of 316 (CART = 215, alloHCT = 101) patients. Median follow-up was 15 and 36 months for the CART and alloHCT cohorts, respectively. In the multivariate analysis, CART was confirmed to be similar to alloHCT for the primary study endpoint (progression-free survival) (hazard ratio [HR] 0.92, CI95%:0.56–1.51, p = 0.75). Furthermore, when the analysis was limited to only patients with chemo-sensitive diseases (complete and partial response) at infusion (CART = 26, alloHCT=93), no differences were reported (progression-free survival at month +18: 65% versus 55%, p = 0.59). However, CART had lower non-relapse mortality (HR 0.34, 95% CI: 0.13–0.85, p = 0.02). Given the lower toxicity and similar survival outcomes, these results suggest the use of CART before alloHCT.

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Fig. 1: Survival outcomes of CART versus alloHCT.


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We thank CERCA Programme/Generalitat de Catalunya for institutional support. We thank Ángel Cedillo for his contribution in obtaining clinical data for the manuscript.

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AM, LB, MBO were responsible for the overall research questions and design of the study. AM, BRS performed the statistical analyses. AM, LB, MBO wrote the original draft. CBMD and SA contributed equally as senior authors. All authors reviewed and revised the manuscript. All authors read and approved the final manuscript.

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Correspondence to Alberto Mussetti.

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We declare no other competing interests for the execution of this study. The data that support the findings of this study are openly available in figshare at

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Mussetti, A., Bento, L., Bastos-Oreiro, M. et al. Role of allogeneic hematopoietic cell transplant for relapsed/refractory aggressive B-cell lymphomas in the CART era. Bone Marrow Transplant (2023).

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