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. 2021 Nov;100(11):2733-2744.
doi: 10.1007/s00277-021-04650-5. Epub 2021 Sep 3.

The role of autologous stem cell transplantation (ASCT) in aggressive B-cell lymphomas: real-world data from a retrospective single-center analysis

Ramona Wullenkord #  1 , Philipp Berning #  1 , Anna-Lena Niemann #  1 , Klaus Wethmar  1 , Sarah Bergmann  1 , Mathias Lutz  1 , Christoph Schliemann  1 , Rolf Mesters  1 , Torsten Keßler  1 , Norbert Schmitz  1 , Wolfgang E Berdel  1 , Georg Lenz  1 , Matthias Stelljes  2
Affiliations

The role of autologous stem cell transplantation (ASCT) in aggressive B-cell lymphomas: real-world data from a retrospective single-center analysis

Ramona Wullenkord et al. Ann Hematol. 2021 Nov.

Abstract

Patients with high-risk or relapsed aggressive B-cell lymphomas are characterized by poor prognosis. High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) can induce durable remissions in these patients and is potentially curative. Two hundred forty-seven patients with aggressive B-cell lymphomas treated with high-dose chemotherapy and ASCT, either as consolidation after first-line therapy or after salvage therapy for relapsed disease, between 2002 and 2019 at the University Hospital Muenster, were analyzed. The median follow-up of surviving patients was 36 months (range 0-163). Progression-free survival (PFS) and overall survival (OS) after 3 years was 63% and 68%, respectively. After ASCT, 28% of all patients experienced a relapse. The cumulative incidence of non-relapse mortality at day 100 after ASCT was 4%. Multivariate analysis identified remission status at ASCT, age at ASCT, and the numbers of infused CD34+ cells as independent prognostic factors for both PFS and OS. Patients with mantle cell lymphoma (MCL) or primary CNS lymphoma (PCNSL) treated with ASCT in first-line had a superior OS and PFS when compared to patients treated with ASCT in relapsed disease. For patients with diffuse large B-cell lymphoma (DLBCL) and Hodgkin lymphoma (HL), early relapse (< 12 months) after first-line therapy showed a trend towards an inferior PFS and OS. Deaths after ASCT were predominantly caused by lymphoma relapse and/or progression (64%) or due to infections (23%). In conclusion, high-dose chemotherapy followed by ASCT in the era of novel targeted agents remains a feasible and effective approach for patients with high-risk or relapsed aggressive B-cell lymphomas. Remission status and age at ASCT, and the number of infused stem cells were of prognostic relevance.

Keywords: Aggressive B-cell lymphoma; Autologous stem cell transplantation; DLBCL; HL; MCL; PCNSL; Prognostic factors.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan–Meier survival estimates showing overall survival (OS) for a DLBCL patients, b Hodgkin lymphoma patients, c mantle cell lymphoma patients, and d primary CNS lymphoma patients. OS curves stratified by time of relapse (< 12 months vs. ≥ 12 months) after first-line treatment in the e de novo DLBCL and f Hodgkin lymphoma subcohorts. Conditional OS by line of therapy of ASCT (first-line [1st line] vs. at relapse) for the g mantle cell lymphoma and h primary CNS lymphoma subcohorts
Fig. 2
Fig. 2
Kaplan–Meier survival estimates showing progression-free (PFS) for a DLBCL patients, b Hodgkin lymphoma patients, c mantle cell lymphoma patients, and d primary CNS lymphoma patients. PFS by time of relapse (< 12 months vs. ≥ 12 months) after first-line treatment for patients with e de novo DLBCL and f for patients with Hodgkin lymphoma. PFS by line of therapy of ASCT (first-line [1st line] vs. at relapse) for g patients with mantle cell lymphoma and h patients with primary CNS lymphoma subcohorts
Fig. 3
Fig. 3
Kaplan–Meier survival estimates showing progression-free survival and overall survival stratified by a–b age at ASCT and c–d remission status at ASCT
See this image and copyright information in PMC

References

    1. Pfreundschuh M, Kuhnt E, Trumper L, Osterborg A, Trneny M, Shepherd L, Gill DS, Walewski J, Pettengell R, Jaeger U, Zinzani PL, Shpilberg O, Kvaloy S, de Nully BP, Stahel R, Milpied N, Lopez-Guillermo A, Poeschel V, Grass S, Loeffler M, Murawski N. CHOP-like chemotherapy with or without rituximab in young patients with good-prognosis diffuse large-B-cell lymphoma: 6-year results of an open-label randomised study of the MabThera International Trial (MInT) Group. Lancet Oncol. 2011;12(11):1013–1022. doi: 10.1016/s1470-2045(11)70235-2. - DOI - PubMed
    1. Crump M, Neelapu SS, Farooq U, Van Den Neste E, Kuruvilla J, Westin J, Link BK, Hay A, Cerhan JR, Zhu L, Boussetta S, Feng L, Maurer MJ, Navale L, Wiezorek J, Go WY, Gisselbrecht C. Outcomes in refractory diffuse large B-cell lymphoma: results from the international SCHOLAR-1 study. Blood. 2017;130(16):1800–1808. doi: 10.1182/blood-2017-03-769620. - DOI - PMC - PubMed
    1. Van Den Neste E, Schmitz N, Mounier N, Gill D, Linch D, Trneny M, Milpied N, Radford J, Ketterer N, Shpilberg O, Dührsen U, Ma D, Brière J, Thieblemont C, Salles G, Moskowitz CH, Glass B, Gisselbrecht C. Outcome of patients with relapsed diffuse large B-cell lymphoma who fail second-line salvage regimens in the International CORAL study. Bone Marrow Transplant. 2016;51(1):51–57. doi: 10.1038/bmt.2015.213. - DOI - PubMed
    1. Engert A, Diehl V, Franklin J, Lohri A, Dörken B, Ludwig WD, Koch P, Hänel M, Pfreundschuh M, Wilhelm M, Trümper L, Aulitzky WE, Bentz M, Rummel M, Sezer O, Müller-Hermelink HK, Hasenclever D, Löffler M. Escalated-dose BEACOPP in the treatment of patients with advanced-stage Hodgkin’s lymphoma: 10 years of follow-up of the GHSG HD9 study. J Clin Oncol. 2009;27(27):4548–4554. doi: 10.1200/jco.2008.19.8820. - DOI - PubMed
    1. Borchmann P, Haverkamp H, Diehl V, Cerny T, Markova J, Ho AD, Eich HT, Mueller-Hermelink HK, Kanz L, Greil R, Rank A, Paulus U, Smardova L, Huber C, Dörken B, Nerl C, Krause SW, Mueller RP, Fuchs M, Engert A. Eight cycles of escalated-dose BEACOPP compared with four cycles of escalated-dose BEACOPP followed by four cycles of baseline-dose BEACOPP with or without radiotherapy in patients with advanced-stage Hodgkin’s lymphoma: final analysis of the HD12 trial of the German Hodgkin Study Group. J Clin Oncol. 2011;29(32):4234–4242. doi: 10.1200/jco.2010.33.9549. - DOI - PubMed

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