| Abstract: |
Autologous hematopoietic cell transplantation (auto-HCT) has long been the standard approach for patients with relapsed/refractory (R/R) chemosensitive diffuse large B cell lymphoma (DLBCL). However, the advent of chimeric antigen receptor (CAR) T cell therapy has caused a paradigm shift in the management of R/R DLBCL patients, especially with the recent approval of CD19-directed CAR-T therapy in the second-line setting in high-risk groups (primary refractory and early relapse [≤12 months]). Consensus on the contemporary role, optimal timing, and sequencing of HCT and cellular therapies in DLBCL is lacking; therefore, the American Society of Transplantation and Cellular Therapy (ASTCT) Committee on Practice Guidelines undertook this project to formulate consensus recommendations to address this unmet need. The RAND-modified Delphi method was used to generate 20 consensus statements with a few key statements as follows: (1) in the first-line setting, there is no role for auto-HCT consolidation for patients achieving complete remission (CR) following R-CHOP (rituximab, cyclophosphamide, adriamycin, vincristine, and prednisone) or similar therapy in non-double-hit/triple-hit cases (DHL/THL) and in DHL/THL cases receiving intensive induction therapies, but auto-HCT may be considered in eligible patients receiving R-CHOP or similar therapies in DHL/THL cases; (2) auto-HCT consolidation with thiotepa-based conditioning is standard of care for eligible patients with primary central nervous system lymphoma achieving CR with first-line therapy; and (3) in the primary refractory and early relapse setting, the preferred option is CAR-T therapy, whereas in late relapse (>12 months), consolidation with auto-HCT is recommended for patients achieving chemosensitivity to salvage therapy (complete or partial response), and CAR-T therapy is recommended for those not achieving remission. These clinical practice recommendations will serve as a tool to guide clinicians managing patients with newly diagnosed and R/R DLBCL. © 2023 The American Society for Transplantation and Cellular Therapy |
| Keywords: |
adult; cancer survival; human tissue; prednisone; cancer recurrence; salvage therapy; doxorubicin; systemic therapy; primary central nervous system lymphoma; rituximab; positron emission tomography; clinical practice; protein bcl 2; consensus; progression free survival; neoplasm recurrence, local; etoposide; recurrence; cyclophosphamide; vincristine; practice guideline; hematopoietic stem cell transplantation; chemosensitivity; thiotepa; health care quality; cancer regression; nonhodgkin lymphoma; nonmyeloablative conditioning; gene rearrangement; lymphoma, non-hodgkin; tumor recurrence; myc protein; reduced intensity conditioning; transplantation conditioning; recurrent disease; chimeric antigen receptor; allogeneic hematopoietic stem cell transplantation; delphi study; protein bcl 6; lymphoma, large b-cell, diffuse; high risk population; cd19 antigen; autologous hematopoietic stem cell transplantation; international prognostic index; allogeneic transplantation; autologous transplantation; second-line treatment; teleconference; diffuse large b cell lymphoma; refractory cancer; consolidation chemotherapy; cellular therapy; humans; human; male; female; article; chimeric antigen receptor t-cell immunotherapy; car t cell therapy; receptors, chimeric antigen
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