Division of Hematology and Medical Oncology, Mayo Clinic, 5777 E. Mayo Boulevard, Phoenix, AZ, USA.
Lymphoma Disease Group, Colorado Blood Cancer Institute, Denver, CO, USA.
Curr Oncol Rep. 2023 Jun;25(6):599-607. doi: 10.1007/s11912-023-01403-7. Epub 2023 Mar 28.
Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive lymphoma in adults. Although curable in the majority of cases, a substantial portion of patients will experience disease relapse and will die from their lymphoma. This review is aimed at summarizing the role of allogeneic hematopoietic stem cell transplant (allo-HSCT) in patients with relapsed DLBCL with a focus on its role in the era of CAR T-cell therapy RECENT FINDINGS: Allo-HSCT is primarily reserved for patients who experience disease progression or relapse after CAR T-cell therapy, largely due to the high non-relapse mortality (NRM) associated with the procedure. Disease status at the time of allo-HSCT is prognostic with complete remission (CR) associated with better outcomes. Reduced-intensity conditioning (RIC) is likely as effective as myeloablative conditioning (MAC) with less toxicity. In patients with multiply relapsed disease, including after auto-HSCT and CAR T-cell therapy, approximately one-third can be cured with allo-HSCT. Allo-HSCT should be considered a treatment modality for fit adults without major comorbid conditions whose disease can be controlled with emerging treatment modalities (e.g., bispecifics, antibody-drug conjugates).
弥漫性大 B 细胞淋巴瘤（DLBCL）是成人中最常见的侵袭性淋巴瘤。尽管大多数病例可以治愈，但仍有相当一部分患者会出现疾病复发，并因淋巴瘤而死亡。本综述旨在总结异基因造血干细胞移植（allo-HSCT）在复发弥漫性大 B 细胞淋巴瘤患者中的作用，重点关注在 CAR T 细胞治疗时代其作用。
allo-HSCT 主要保留给在 CAR T 细胞治疗后出现疾病进展或复发的患者，主要是因为该治疗程序相关的非复发死亡率（NRM）较高。allo-HSCT 时的疾病状态具有预后意义，完全缓解（CR）与更好的结果相关。与清髓性预处理（MAC）相比，减低强度预处理（RIC）可能同样有效，但毒性较小。对于多次复发的疾病患者，包括自体 HSCT 和 CAR T 细胞治疗后，大约三分之一的患者可以通过 allo-HSCT 治愈。allo-HSCT 应被视为适合无主要合并症的健康成年人的治疗方式，其疾病可以通过新兴的治疗方式（例如双特异性药物、抗体药物偶联物）得到控制。
