Blood Cancer Journal (Jul 2024)

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

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

DOI
https://doi.org/10.1038/s41408-024-01084-w
Journal volume & issue
Vol. 14, no. 1
pp. 1 – 7

Abstract

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Abstract 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.