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Outcomes of allogeneic hematopoietic stem cell transplantation for relapsed or refractory diffuse large B-cell lymphoma

Bone Marrow Transplantation volume 59, pages 306–314 (2024)Cite this article

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Abstract

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a currative treatment modality for diffuse large B-cell lymphoma (DLBCL) because of the intrinsic graft-versus-lymphoma effect. However, limited information is available regarding which patients with relapsed or refractory DLBCL are likely to benefit from allo-HSCT. We retrospectively analyzed data from 1268 DLBCL patients who received allo-HSCT. The overall survival and progression-free survival (PFS) rates were 30.3% and 21.6% at 3 years, respectively. Multivariate analysis revealed that stable or progressive disease at transplantation, male patient, poorer performance status at transplantation, and shorter intervals from previous transplantation were associated independently with a lower PFS. Four prognostic factors were used to construct a prognostic index for PFS, predicting 3-year PFS of 55.4%, 43.7%, 20.4% and 6.6%, respectively. The prognostic model predicted relapse rates following allo-HSCT accordingly (P < 0.0001), whereas did not predict transplantation-related mortality (P = 0.249). The prognostic index can identify a subgroup of DLBCL patients who benefit from allo-HSCT and it is worthwhile to evaluate whether this model is also applicable to patients undergoing allo-HSCT in cases of relapse after chimeric antigen receptor engineered T-cell therapy, although the application of allo-HSCT has been declining with the increase of novel immunotherapies.

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Fig. 1: Survival rates of patients with diffuse large B-cell lymphoma (DLBCL) receiving allogeneic hematopoietic stem cell transplantation (allo-HSCT).
Fig. 2: Cumulative incidence curves of relapse and transplantation-related mortality (TRM) in DLBCL patients treated with allo-HSCT.
Fig. 3: The prognostic index for survival in DLBCL patients receiving allo-HSCT.
Fig. 4: Cumulative incidence curves of relapse and TRM according to the prognostic index.

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Data availability

The data that support the findings of this study are available from the Japan Society for Hematopoietic Cell Transplantation (JSHCT) but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of JSHCT.

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Acknowledgements

We thank the physicians and data managers at the institutes who contributed valuable data regarding adult lymphoma-related transplantation to the JSHCT. We also thank all members of the data management committees of the JSHCT.

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Authors and Affiliations

  1. Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan

    Koji Kato, Takeshi Sugio & Yasuo Mori

  2. Division of Hematology and Stem Cell Transplantation, Shizuoka Cancer Center, Shizuoka, Japan

    Takashi Ikeda & Kanako Yoshitsugu

  3. Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Japan

    Kana Miyazaki

  4. Department of Hematology, Koga Community Hospital, Yaizu, Japan

    Junji Suzumiya

  5. Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan

    Go Yamamoto

  6. Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan

    Sung-Won Kim & Takahiro Fukuda

  7. Department of Hematology, Hyogo Medical University Hospital, Nishinomiya, Japan

    Kazuhiro Ikegame

  8. Department of Hematology, Kitakyushu Municipal Medical Center, Kitakyushu, Japan

    Yasufumi Uehara

  9. Department of Hematology, Osaka International Cancer Institute, Osaka, Japan

    Jun Ishikawa

  10. Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan

    Nobuhiro Hiramoto

  11. Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan

    Tetsuya Eto

  12. Department of Hematology and Medical Oncology, Shinshu University School of Medicine, Matsumoto, Japan

    Hideyuki Nakazawa

  13. Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan

    Hikaru Kobayashi

  14. Division of Hematology and Rheumatology, Department of Internal Medicine, Kindai University Hospital, Osaka, Japan

    Kentaro Serizawa

  15. Department of Hematology/Oncology, Tokai University School of Medicine, Isehara, Japan

    Makoto Onizuka

  16. Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan

    Yoshiko Atsuta

  17. Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan

    Yoshiko Atsuta

  18. Department of Hematology and Oncology, Shimane University School of Medicine, Izumo, Japan

    Ritsuro Suzuki

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  1. Koji Kato
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Contributions

KK, TS, TI, KY, KM, JS, and RS designed the study; KK, GY, SK, KI, YU, YM, JI, NH, TE, HN, HK, KS, OM, TF, and YA collected the data; KK and TS performed the statistical analysis. KK and TS wrote the manuscript and created the figures and tables; all authors critically reviewed the manuscript and read and approved the final version of the manuscript.

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Correspondence to Koji Kato.

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Competing interests

KK; Honoraria: Bristol-Myers Squibb, Celgene, Dainippon-Sumitomo, Janssen, Kyowa Kirin, MSD, Ono; Consulting or Advisory Role: AbbVie, AstraZeneca, Celgene, Chugai Pharmaceutical, Daiichi Sankyo, Eisai, Janssen, Novartis; Research Funding: AbbVie, MSD, Bristol-Myers Squibb, Celgene, Chugai, Daiichi Sankyo, Eisai, Janssen, Kyowa Kirin, Novartis, Ono. KM; Honoraria: Chugai Pharma, SymBio Pharmaceuticals, Janssen, Eisai, Nippon Shinyaku, AstraZeneca, Bristol-Myers Squibb, Meiji Seika Pharma, Abbvie, Novartis, Incyte, Asahi Kasei; Research Funding: Eisai, Takeda, Nipoon Shinyaku, Otsuka, Chugai Pharma, Asahi Kasei, Sumitomo Dainippon Pharma Oncology, Zenyaku Kogyo. KS; Honoraria: Janssen, Sanofi, Takeda. Ritsuro Suzuki; Honoraria: Chugai, Kyowa Kirin, Takeda, Meiji Seika, Abbvie, AstraZeneca, Janssen, Otsuka, Eisai, Nippon Shinyaku, Elli Lilly, Amgen, Novartis, Nihon Kayaku, Sumitomo; Research Funding: Chugai, Kyowa Kirin, Takeda, Eisai, Shionogi, Otsuka, Taiho.

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Kato, K., Sugio, T., Ikeda, T. et al. Outcomes of allogeneic hematopoietic stem cell transplantation for relapsed or refractory diffuse large B-cell lymphoma. Bone Marrow Transplant 59, 306–314 (2024). https://doi.org/10.1038/s41409-023-02156-4

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