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): Bone Marrow Transplantation

E. González-Barca, A. Boumendil, D. Blaise, M. Trněný, T. Masszi, H. Finel, M.G. Michieli, J.T. Bittenbring, G. Gritti, J.A. Snowden, M. Bishton, B. Bruno, S.G. de Villambrosia, A. Janikova, X. Leleu, A. Anagnostopoulos, X. Poiré, M. Crysandt, Z.N. Özkurt, E. VandenbergheM. Itälä-Remes, J.Y. Cahn, E. Jantunen, W. Schroyens, J. Maertens, A. Esquirol, P. Dreger, S. Montoto, A. Sureda

Research output: Contribution to journalArticlepeer-review

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. © 2019, The Author(s), under exclusive licence to Springer Nature Limited.
Original languageEnglish
Pages (from-to)393-399
Number of pages7
JournalBone Marrow Transplant.
Volume55
Issue number2
DOIs
Publication statusPublished - 2020

Keywords

  • adult
  • aged
  • Article
  • autologous stem cell transplantation
  • cancer prognosis
  • cancer recurrence
  • cancer registry
  • clinical effectiveness
  • diffuse large B cell lymphoma
  • female
  • follow up
  • human
  • major clinical study
  • male
  • multicenter study
  • overall survival
  • priority journal
  • retrospective study
  • salvage therapy
  • survival rate
  • treatment outcome
  • trend study

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