Autologous transplant vs chimeric antigen receptor T-cell therapy for relapsed DLBCL in partial remission Journal Article
| Authors: | Shadman, M.; Pasquini, M.; Ahn, K. W.; Chen, Y.; Turtle, C. J.; Hematti, P.; Cohen, J. B.; Khimani, F.; Ganguly, S.; Merryman, R. W.; Yared, J. A.; Locke, F. L.; Ahmed, N.; Munshi, P. N.; Beitinjaneh, A.; Reagan, P. M.; Herrera, A. F.; Sauter, C. S.; Kharfan-Dabaja, M. A.; Hamadani, M. |
| Article Title: | Autologous transplant vs chimeric antigen receptor T-cell therapy for relapsed DLBCL in partial remission |
| 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. © 2022 American Society of Hematology |
| Keywords: | adolescent; adult; cancer survival; controlled study; aged; aged, 80 and over; disease-free survival; middle aged; survival rate; major clinical study; overall survival; busulfan; fludarabine; mortality; cancer recurrence; comparative study; disease free survival; cytarabine; cancer staging; neurotoxicity; positron emission tomography; follow up; progression free survival; computer assisted tomography; infection; etoposide; incidence; cohort analysis; recurrence; cyclophosphamide; melphalan; hematopoietic stem cell transplantation; carmustine; cause of death; cancer regression; karnofsky performance status; transplantation conditioning; recurrent disease; multivariate logistic regression analysis; lactate dehydrogenase; lymphoma, large b-cell, diffuse; autograft; lactate dehydrogenase blood level; adoptive immunotherapy; immunotherapy, adoptive; multiple organ failure; cumulative incidence; leukapheresis; comparative effectiveness; autotransplantation; clinical outcome; cytokine release syndrome; diffuse large b cell lymphoma; autografts; palliative chemotherapy; very elderly; humans; human; male; female; article; disease assessment; chimeric antigen receptor t-cell immunotherapy; axicabtagene ciloleucel; immune effector cell associated neurotoxicity syndrome |
| Journal Title: | Blood |
| Volume: | 139 |
| Issue: | 9 |
| ISSN: | 0006-4971 |
| Publisher: | American Society of Hematology |
| Date Published: | 2022-03-09 |
| Start Page: | 1330 |
| End Page: | 1339 |
| Language: | English |
| DOI: | 10.1182/blood.2021013289 |
| PUBMED: | 34570879 |
| PROVIDER: | scopus |
| PMCID: | PMC8900276 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 April 2022 -- Source: Scopus |
