Autologous hematopoietic cell transplant (auto-HCT) decreases relapse and increases survival compared with CAR-T.

  • Major Finding: Autologous hematopoietic cell transplant (auto-HCT) decreases relapse and increases survival compared with CAR-T.

  • Concept: A retrospective study compared clinical outcomes in partial remission patients who received auto-HCT or CAR-T.

  • Impact: This work supports auto-HCT as standard-of-care for this subset of DLBCL patients post-salvage therapy.

Diffuse large B-cell lymphoma (DLBCL) has a 60% response rate to current first-line therapies, but those who do not respond have generally poor outcomes. A clinical unmet need, therefore, resides in determining the best treatment strategy for these patients. The standard-of-care for individuals who achieve complete remission after salvage treatment includes high-dose chemotherapy and autologous hematopoietic cell transplant (auto-HCT). Patients who achieve a partial remission (PR) are also candidates for chimeric antigen receptor T-cell (CAR-T) therapy, but the efficacy of auto-HCT and CAR-T in these patients has yet to be compared. Shadman and colleagues reviewed the Center for International Blood & Marrow Transplant Research registry database and identified 411 patients who received auto-HCT or CAR-T treatment using axicabtagene ciloleucel while in PR. No difference in the 2-year progression-free survival or the 100-day non-relapse mortality rate was observed between the two groups. However, auto-HCT was correlated with a lower rate of relapse/progression at 1 year and 2 years as well as with better overall survival over 2 years. Subgroup analysis using only patients with early treatment failure (defined as primary refractory disease or relapse within one year of diagnosis) also revealed a significant reduction in relapse/progression rate and superior overall survival for the auto-HCT group at 2 years. Moreover, patients treated with CAR-T exhibited a higher risk of relapse/progression as compared with auto-HCT. In summary, these results indicate auto-HCT is associated with a reduced relapse incidence and improved overall survival, supporting the notion that auto-HCT should be the standard of care for patients with DLBCL in PR after salvage therapy.

Shadman M, Pasquini MC, Ahn KW, Chen Y, Turtle CJ, Hematti P, et al. Autologous transplant versus chimeric antigen receptor T-cell therapy for relapsed DLBCL in partial remission. Blood 2021 Sep 27 [Epub ahead of print]

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