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Stem Cell Mobilization and Autologous Transplantation Outcomes After First-Line R-DA-EPOCH in High-Risk DLBCL and
Daniela Taurino1, Giulia Figini1,2, Francesca Ricci1
1Bone Marrow Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy.
Insights
First-line dose-adjusted R-EPOCH (R-DA-EPOCH) effectively mobilizes stem cells for most high-risk diffuse large B-cell lymphoma (DLBCL) and high-grade B-cell lymphoma (HGBCL) patients, though some need plerixafor (PLX) support for autologous stem cell transplantation (ASCT).
Area of Science:
- Hematology
- Oncology
- Stem Cell Transplantation
Background:
- High-risk diffuse large B-cell lymphoma (DLBCL) and high-grade B-cell lymphoma (HGBCL) patients have poor outcomes with standard treatments.
- Dose-adjusted R-EPOCH (R-DA-EPOCH) is utilized in high-risk settings and may aid stem cell mobilization for autologous stem cell transplantation (ASCT).
Purpose of the Study:
- To assess the impact of first-line R-DA-EPOCH on stem cell mobilization.
- To evaluate the outcomes of autologous stem cell transplantation (ASCT) following R-DA-EPOCH therapy.
Main Methods:
- Retrospective analysis of 41 adult patients with high-risk DLBCL/HGBCL treated with first-line R-DA-EPOCH (2016-2021).
- Stem cell collection was planned post-cycle 5.
- Primary endpoint: rate of poor mobilizers (<2 × 10^6 CD34+ cells/kg or requiring plerixafor [PLX]).
Main Results:
- 31.7% of patients were poor mobilizers, with 22% requiring PLX.
- 68% achieved target stem cells on first mobilization; 88% after remobilization.
- 59% proceeded to ASCT with successful engraftment and no transplant-related mortality.
Conclusions:
- First-line R-DA-EPOCH facilitates effective stem cell mobilization in most high-risk DLBCL/HGBCL patients.
- A significant proportion of patients require PLX for adequate stem cell collection.
- R-DA-EPOCH serves as a feasible platform for early mobilization and ASCT in selected patients.
Background/Objectives:
Patients with high-risk diffuse large B-cell lymphoma (DLBCL) and high-grade B-cell lymphoma (HGBCL) have suboptimal outcomes with standard therapies. Dose-adjusted R-EPOCH (R-DA-EPOCH) is often used in selected high-risk settings and may also serve as an effective chemo-mobilizing strategy for autologous stem cell transplantation (ASCT). We aimed to evaluate the impact of first-line R-DA-EPOCH on stem cell mobilization and transplantation outcomes.
Methods:
We retrospectively analyzed 41 consecutive adult patients with high-risk DLBCL/HGBCL treated with first-line R-DA-EPOCH between 2016 and 2021. Stem cell collection was planned after cycle 5. The primary endpoint was the rate of poor mobilizers, defined as patients who collected <2 × 106 CD34+ cells/kg or required plerixafor (PLX) to achieve this threshold.
Results:
The rate of poor mobilizers was 31.7% (13/41), with 22% (9/41) of patients requiring PLX. Overall, 68% of patients achieved ≥2 × 106 CD34+ cells/kg at first mobilization, while 88% ultimately reached the target after remobilization. Mobilization failure occurred in 12% of patients. A total of 59% of patients proceeded to ASCT. Engraftment was achieved in all transplanted patients, with no transplant-related mortality.
Conclusions:
First-line R-DA-EPOCH enables effective stem cell mobilization in most high-risk DLBCL and HGBCL patients, although a substantial proportion require PLX support. These findings suggest that R-DA-EPOCH is a feasible platform for early mobilization and ASCT in selected patients.
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