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

IF 12.9 1区医学 Q1 HEMATOLOGY Blood Cancer Journal Pub Date : 2024-07-08 DOI:10.1038/s41408-024-01084-w

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

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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.

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完全缓解期 DLBCL 患者的自体移植与 CAR-T 疗法对比

对于完全缓解（CR）的复发性DLBCL患者，自体造血细胞移植（auto-HCT）和CAR-T疗法都很有效，但哪种方法疗效更好尚不清楚。我们比较了自体造血细胞移植与 CAR-T 在 CR 期 DLBCL 患者中的疗效。这是一项回顾性观察研究，利用国际血液& 骨髓移植研究中心的登记资料，比较了自体血细胞移植（2015-2021年）与CAR-T（2018-2021年）。自体血细胞移植的中位随访时间为49.7个月，CAR-T队列的中位随访时间为24.7个月。年龄在18至75岁之间、诊断为DLBCL的患者，如果在CR期间接受了自体血细胞移植（281人）或商业CAR-T（79人），均被纳入研究范围。接受自体血细胞移植且之前只接受过一种疗法的患者和之前接受过自体血细胞移植治疗的 CAR-T 患者不包括在内。终点包括无进展生存期（PFS）、复发率、非复发死亡率（NRM）和总生存期（OS）。在单变量分析中，采用自体血细胞移植治疗与较高的两年无进展生存率（66.2% vs. 47.8%；p < 0.001）、较低的两年累计复发率（27.8% vs. 48%；p < 0.001）和较好的两年总生存率（78.9% vs. 65.6%；p = 0.037）相关。在早期（12个月内）治疗失败的患者中，自体血细胞移植与较好的2年PFS（70.9% vs. 48.3%; p <0.001）、较低的2年累计复发率（22.8% vs. 45.9%; p <0.001）和较高的2年OS（82.4% vs. 66.1%; p = 0.076）相关。在多变量分析中，与CAR-T相比，自体血细胞移植治疗具有更优的PFS（危险比1.83；p = 0.0011）和更低的复发率（危险比2.18；p <；0.0001）。对于达到CR的复发LBCL患者，与CAR-T相比，自体血细胞移植治疗可改善临床预后。这些数据支持考虑在复发的LBCL患者中选择达到CR的患者进行自体血细胞移植。

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来源期刊

Blood Cancer Journal ONCOLOGY-

CiteScore

16.70

自引率

2.30%

发文量

153

审稿时长

>12 weeks

期刊介绍： Blood Cancer Journal is dedicated to publishing high-quality articles related to hematologic malignancies and related disorders. The journal welcomes submissions of original research, reviews, guidelines, and letters that are deemed to have a significant impact in the field. While the journal covers a wide range of topics, it particularly focuses on areas such as: Preclinical studies of new compounds, especially those that provide mechanistic insights Clinical trials and observations Reviews related to new drugs and current management of hematologic malignancies Novel observations related to new mutations, molecular pathways, and tumor genomics Blood Cancer Journal offers a forum for expedited publication of novel observations regarding new mutations or altered pathways.