Journal Article

Autologous transplant vs. CAR-T therapy in patients with DLBCL treated while in complete remission

Hossain, Nasheed M., Kaur, Manmeet, Khimani, Farhad, Iqbal, Madiha, Ahmed, Nausheen, Shadman, Mazyar, Savani, Bipin, Brammer, Jonathan, Lekakis, Lazaros, Kharfan-Dabaja, Mohamed A., Shah, Nirav, Sauter, Craig, Ulrickson, Matthew, Ghosh, Nilanjan, Hertzberg, Mark, Lazaryan, Aleksandr, Hamadani, Mehdi, Hill, Brian, Riedell, Peter, Ahn, Kwang W., Gopal, Ajay K., Ram, Ron, Merryman, Reid, Awan, Farrukh, Frigault, Matthew, Grover, Natalie, Kenkre, Vaishalee P., Beitinjaneh, Amer, Herrera, Alex, Ahmed, Sairah

2024

Overview

In patients with relapsed DLBCL in complete remission (CR), autologous hematopoietic cell transplantation (auto-HCT) and CAR-T therapy are both effective, but it is unknown which modality provides superior outcomes. We compared the efficacy of auto-HCT vs. CAR-T in patients with DLBCL in a CR. A retrospective observational study comparing auto-HCT (2015–2021) vs. CAR-T (2018–2021) using the Center for International Blood & Marrow Transplant Research registry. Median follow-up was 49.7 months for the auto-HCT and 24.7 months for the CAR-T cohort. Patients ages 18 and 75 with a diagnosis of DLBCL were included if they received auto-HCT ( n  = 281) or commercial CAR-T ( n  = 79) while in a CR. Patients undergoing auto-HCT with only one prior therapy line and CAR-T patients with a previous history of auto-HCT treatment were excluded. Endpoints included Progression-free survival (PFS), relapse rate, non-relapse mortality (NRM) and overall survival (OS). In univariate analysis, treatment with auto-HCT was associated with a higher rate of 2-year PFS (66.2% vs. 47.8%; p  < 0.001), a lower 2-year cumulative incidence of relapse (27.8% vs. 48% ; p  < 0.001), and a superior 2-year OS (78.9% vs. 65.6%; p  = 0.037). In patients with early (within 12 months) treatment failure, auto-HCT was associated with a superior 2-year PFS (70.9% vs. 48.3% ; p  < 0.001), lower 2-year cumulative incidence of relapse (22.8% vs. 45.9% ; p  < 0.001) and trend for higher 2-year OS (82.4% vs. 66.1% ; p  = 0.076). In the multivariable analysis, treatment with auto-HCT was associated with a superior PFS (hazard ratio 1.83; p  = 0.0011) and lower incidence of relapse (hazard ratio 2.18; p  < 0.0001) compared to CAR-T. In patients with relapsed LBCL who achieve a CR, treatment with auto-HCT is associated with improved clinical outcomes compared to CAR-T. These data support the consideration of auto-HCT in select patients with LBCL achieving a CR in the relapsed setting.

• Publisher: Nature Publishing Group UK,Springer Nature B.V,Nature Publishing Group
• Subject: 692/699/67/1059/2325 / 692/700/565/1436/1437 / Adolescent / Adult / Aged / Biomedical and Life Sciences / Biomedicine / Cancer Research / Female / Hematology / Hematopoietic Stem Cell Transplantation - methods / Humans / Immunotherapy, Adoptive - methods / Lymphoma, Large B-Cell, Diffuse - mortality / Lymphoma, Large B-Cell, Diffuse - therapy / Male / Middle Aged / Oncology / Pathologic Complete Response / Remission Induction / Retrospective Studies / Transplantation, Autologous / Transplants & implants / Treatment Outcome / Young Adult