Abstract
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.
Note: Research Watch is written by Cancer Discovery editorial staff. Readers are encouraged to consult the original articles for full details. For more Research Watch, visit Cancer Discovery online at http://cancerdiscovery.aacrjournals.org/CDNews.
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