Format

Send to

Choose Destination
Bone Marrow Transplant. 2019 Sep 20. doi: 10.1038/s41409-019-0650-x. [Epub ahead of print]

Outcome in patients with diffuse large B-cell lymphoma who relapse after autologous stem cell transplantation and receive active therapy. A retrospective analysis of the Lymphoma Working Party of the European Society for Blood and Marrow Transplantation (EBMT).

Author information

1
Institut Català d'Oncologia, Hospital Duran i Reynals, IDIBELL, Barcelona, Spain. e.gonzalez@iconcologia.net.
2
EBMT Paris Study Office, Paris, France.
3
Institut Paoli Calmettes, Department of Hematology, Marseille, France.
4
1st Charles University General Hospital, Prague, Czech Republic.
5
St. István and St. Laszlo Hospital, Budapest, Hungary.
6
Centro di Riferimento Oncologico, Aviano, Italy.
7
University of Saarland, Homburg, Germany.
8
Papa Giovanni XXIII Hospital, Bergamo, Italy.
9
Sheffield Teaching Hospitals, Sheffield, UK.
10
Department of Hematology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
11
Department of Molecular Biotechnology and Health Sciences, AOU Città della Salute e della Scienza, University of Torino, Torino, Italy.
12
Department of Hematology, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
13
Department of Hematology and Oncology, University Hospital Brno, Brno, Czech Republic.
14
Service D'Hématologie Et Thérapie Cellulaire, Hopital de La Milétrie, Poitiers, France.
15
Hematology Department & HCT Unit, G. Papanikolaou Hospital, Thessaloniki, Greece.
16
Section of Hematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
17
Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen University, Aachen, Germany.
18
Gazi University Faculty of Medicine, Ankara, Turkey.
19
St James Hospital and Trinity College Dublin, Dublin, Ireland.
20
Turku University Hospital, Stem Cell Transplantation Unit, Turku, Finland.
21
Department of Hematology, Hopital A. Michallon, Grenoble, FRA, France.
22
University of Eastern Finland/Institute of Clinical Medicine/Internal Medicine, Kuopio, Finland.
23
Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
24
Siunsote-North Carelia Hospital District, Joensuu, Finland.
25
University of Antwerp, Antwerp University Hospital, Dept. of Hematology, Antwerp, Belgium.
26
Department of Hematology, University Hospital Gasthuisberg, Dept. of Hematology, Leuven, Belgium.
27
Hospital de la Santa Creu i Sant Pau, Clinical Hematology Service, Barcelona, Spain.
28
Department of Medicine V, University of Heidelberg, Heidelberg, Germany.
29
Haemato-Oncology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
30
Institut Català d'Oncologia, Hospital Duran i Reynals, IDIBELL, Barcelona, Spain.

Abstract

Autologous hematopoietic stem cell transplantation (auto-HSCT) is the standard of care for patients with diffuse large B-cell lymphoma (DLBCL) who relapse/progress after first line chemoimmunotherapy. Long-term outcome of those who relapse after transplant is poor. We present the results of a retrospective study of 256 adult patients reported to the EBMT registry with DLBCL who relapsed after auto-HSCT performed between 2003 and 2013, and who received active salvage strategies. One hundred and fifty-four (60%) were male; median age was 53 years. Median time to relapse was 7 months, 65% relapsed during the first year. Overall response rate after salvage therapy was 46%. Median follow-up after first salvage therapy was 40 months (IQR 23-63 months). Overall survival (OS) at 3 years was 27% (95% CI 22-33). OS at 3 years of patients relapsing longer than 1 year after auto-HSCT was 41% (95% CI 31-53) compared with 20% (95% CI 14-24) in those who relapsed in less than 1 year. Eighty-two patients (32%) had a second HSCT, an allogeneic HSCT (allo-HSCT) in 69 cases, at a median time of 6.5 months after relapse. OS at 3 years after allo-HSCT was 36% (95% CI 25-51). In conclusion, the prognosis of patients with DLBCL that relapse after auto-HSCT is dismal. Patients who relapse in less than 1 year remain an unmet need, and should be considered for CAR T cell therapy or clinical trials. Patients who relapse after 1 year can be rescued with salvage therapies and a second HSCT. These results provide a benchmark to compare data of new prospective studies.

PMID:
31541205
DOI:
10.1038/s41409-019-0650-x

Supplemental Content

Full text links

Icon for Nature Publishing Group
Loading ...
Support Center