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Comparative Study
. 2022 Mar 3;139(9):1330-1339.
doi: 10.1182/blood.2021013289.

Autologous transplant vs chimeric antigen receptor T-cell therapy for relapsed DLBCL in partial remission

Mazyar Shadman  1   2 , Marcelo Pasquini  3 , Kwang Woo Ahn  3   4 , Yue Chen  3 , Cameron J Turtle  1   2 , Peiman Hematti  5 , Jonathon B Cohen  6 , Farhad Khimani  7 , Siddhartha Ganguly  8 , Reid W Merryman  9 , Jean A Yared  10 , Frederick L Locke  7 , Nausheen Ahmed  8 , Pashna N Munshi  11 , Amer Beitinjaneh  12 , Patrick M Reagan  13 , Alex F Herrera  14 , Craig S Sauter  15   16 , Mohamed A Kharfan-Dabaja  17 , Mehdi Hamadani  3   18
Affiliations
Comparative Study

Autologous transplant vs chimeric antigen receptor T-cell therapy for relapsed DLBCL in partial remission

Mazyar Shadman et al. Blood. .

Abstract

The relative efficacy of autologous hematopoietic cell transplant (auto-HCT) vs chimeric antigen receptor T-cell (CAR-T) therapy in patients with diffuse large B-cell lymphoma (DLBCL) who achieve a partial remission (PR) after salvage chemotherapy is not known. Using the Center for International Blood & Marrow Transplant Research registry database, we identified adult patients with DLBCL who received either an auto-HCT (2013-2019) or CAR-T treatment with axicabtagene ciloleucel (2018-2019) while in a PR by computed tomography or positron emission tomography scan. We compared the clinical outcomes between the 2 cohorts using univariable and multivariable regression models after adjustment for relevant baseline and clinical factors. In the univariable analysis, the 2-year progression-free survival (52% vs 42%; P = .1) and the rate of 100-day nonrelapse mortality (4% vs 2%; P = .3) were not different between the 2 cohorts, but consolidation with auto-HCT was associated with a lower rate of relapse/progression (40% vs 53%; P = .05) and a superior overall survival (OS) (69% vs 47%; P = .004) at 2 years. In the multivariable regression analysis, treatment with auto-HCT was associated with a significantly lower risk of relapse/progression rate (hazard ratio = 1.49; P = .01) and a superior OS (hazard ratio = 1.63; P = .008). In patients with DLBCL in a PR after salvage therapy, treatment with auto-HCT was associated with a lower incidence of relapse and a superior OS compared with CAR-T. These data support the role of auto-HCT as the standard of care in transplant-eligible patients with relapsed DLBCL in PR after salvage therapy.

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Figures

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Graphical abstract
Figure 1.
Figure 1.
Auto-HCT vs CAR-T in patients with DLBCL in PR (all patients). (A) Progression-free survival. (B) Nonrelapse mortality. (C) Progression/relapse. (D) Overall survival.
Figure 2.
Figure 2.
Auto-HCT vs CAR-T in patients with DLBCL in PR (patients with ≤2 prior lines of treatment). (A) Progression-free survival. (B) Nonrelapse mortality. (C) Progression/relapse. (D) Overall survival.
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References

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