Autologous transplant for patients with chemotherapy-sensitive late relapse of diffuse large B-cell lymphoma

In the era of chimeric antigen receptor (CAR) T-cell therapy, autologous stem cell transplant (ASCT) for diffuse large B-cell lymphoma (DLBCL) is preferentially offered to patients with late relapse (>12 months) who achieve complete or partial response (CR or PR, respectively) to salvage therapy. We conducted a retrospective cohort study using publicly available data from the Center for International Blood and Marrow Transplant Research in this population. We included adult patients with DLBCL, not otherwise specified, and high-grade large B-cell lymphomas who experienced disease relapsed after remaining on a response to first line of treatment for at least 12 months and who achieved a CR or PR after salvage treatment at the time of relapse. A total of 182 patients treated between 2013 and 2021 were included in the analysis: 100 had CR and 82 had PR before ASCT. Median follow-up after ASCT was 34 months (range, 1-95). Overall survival (OS) at 3 years was 67.6%, and progression-free survival (PFS) was 50.6%. Cumulative incidence of relapse at 3 years was 43.9%. Older age (hazard ratio [HR], 1.03; P = .026) and a higher number of previous lines of treatment (HR, 1.43; P = .002) were associated with inferior OS. Multivariable analysis showed that the number of previous treatments had a significant impact on the OS (P = .009), whereas undergoing ASCT in a PR status was the only factor significantly associated with inferior PFS (P = .029; HR, 1.41; 95% confidence interval, 1.09-1.82). In summary, ASCT still provides high efficacy in patients experiencing late relapses (after 12 months) who have chemotherapy-sensitive disease after pretransplant salvage.