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适合自体干细胞移植的反应性或早期复发的耐药或缓解不良弥漫大 B 细胞淋巴瘤患者。

Autologous stem cell transplant in fit patients with refractory or early relapsed diffuse large B-cell lymphoma that responded to salvage chemotherapy.

机构信息

Division of Hematology, Mayo Clinic, Rochester, Minnesota; Division of Hematologic Malignancies and Cellular Therapeutics, The University of Kansas, Kansas City.

Division of Hematology, Mayo Clinic, Rochester, Minnesota.

出版信息

Haematologica. 2024 Jul 1;109(7):2186-2195. doi: 10.3324/haematol.2023.284704.


DOI:10.3324/haematol.2023.284704
PMID:38235513
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11215374/
Abstract

Chimeric antigen receptor T-cell therapy is the new standard of care in fit patients with refractory or early relapsed diffuse large B-cell lymphoma (DLBCL). However, there may still be a role for salvage chemotherapy (ST) and autologous stem cell transplant (ASCT) in certain circumstances (e.g., lack of resources for chimeric antigen receptor T-cell therapy, chemosensitive relapses). We retrospectively studied 230 patients with refractory or early relapsed DLBCL who underwent ST and ASCT. The median line of ST was one (range, 1-3). Best response before ASCT was complete response in 106 (46%) and partial response in 124 (54%) patients. The median follow-up after ASCT was 89.4 months. The median progression-free (PFS) and overall survival (OS) were 16.1 and 43.3 months, respectively. Patients relapsing between 6 to 12 months after frontline therapy had a numerically better median PFS (29.6 months) and OS (88.5 months). Patients who required one line of ST, compared to those requiring more than one line, had a better median PFS (37.9 vs. 3.9 months; P=0.0005) and OS (68.3 vs. 12.0 months; P=0.0005). Patients who achieved complete response had a better median PFS (71.1 vs. 6.3 months; P<0.0001) and OS (110.3 vs. 18.9 months; P<0.0001) than those in partial response. Patients who achieved complete response after one line of ST had the most favorable median PFS (88.5 months) and OS (117.2 months). Post-ASCT survival outcomes of patients with refractory or early relapsed DLBCL appeared reasonable and were particularly favorable in those who required only one line of ST to achieve complete response before ASCT, highlighting the role of this procedure in select patients with chemosensitive disease.

摘要

嵌合抗原受体 T 细胞疗法是适合的难治性或早期复发弥漫性大 B 细胞淋巴瘤 (DLBCL) 患者的新标准治疗方法。然而,在某些情况下,挽救化疗 (ST) 和自体干细胞移植 (ASCT) 可能仍然有作用(例如,缺乏嵌合抗原受体 T 细胞治疗的资源,对化疗敏感的复发)。我们回顾性研究了 230 例接受 ST 和 ASCT 的难治性或早期复发 DLBCL 患者。ST 的中位线为 1 次(范围,1-3 次)。ASCT 前的最佳反应为 106 例(46%)完全缓解和 124 例(54%)部分缓解。ASCT 后中位随访时间为 89.4 个月。中位无进展生存期(PFS)和总生存期(OS)分别为 16.1 和 43.3 个月。一线治疗后 6 至 12 个月复发的患者中位 PFS(29.6 个月)和 OS(88.5 个月)均有较好的数值。与需要多线 ST 的患者相比,仅需要一线 ST 的患者中位 PFS(37.9 个月)和 OS(68.3 个月)更好(P=0.0005)。完全缓解的患者中位 PFS(71.1 个月)和 OS(110.3 个月)优于部分缓解的患者(P<0.0001)。仅接受一线 ST 即可达到完全缓解的患者的中位 PFS(88.5 个月)和 OS(117.2 个月)最为有利。接受 ASCT 后难治性或早期复发 DLBCL 患者的生存结局似乎合理,尤其是在那些仅需一线 ST 即可达到完全缓解的患者中,这突出了该程序在选择对化疗敏感的患者中的作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7043/11215374/61e35f3a5150/1092186.fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7043/11215374/af42c2072720/1092186.fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7043/11215374/c0a53d621277/1092186.fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7043/11215374/61e35f3a5150/1092186.fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7043/11215374/af42c2072720/1092186.fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7043/11215374/c0a53d621277/1092186.fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7043/11215374/61e35f3a5150/1092186.fig3.jpg

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引用本文的文献

[1]
Long-term follow-up of autologous hematopoietic cell transplantation for diffuse large B cell lymphoma in the rituximab era: real‑world data from a retrospective single‑center analysis.

Ann Hematol. 2025-6-3

[2]
Phase II Trial of Hypofractionated Radiotherapy and Immunochemotherapy in Primary Refractory Diffuse Large B-Cell Lymphoma: Preliminary Results and Insights from Digital Spatial Profiling.

MedComm (2020). 2025-5-25

[3]
Current treatment approach and future perspectives in B cell lymphoma.

Int J Hematol. 2025-3

本文引用的文献

[1]
Overcoming Barriers to Referral for Chimeric Antigen Receptor T Cell Therapy in Patients with Relapsed/Refractory Diffuse Large B Cell Lymphoma.

Transplant Cell Ther. 2023-7

[2]
Allogeneic BCMA-targeting CAR T cells in relapsed/refractory multiple myeloma: phase 1 UNIVERSAL trial interim results.

Nat Med. 2023-2

[3]
Outcomes of Older Adults with Non-Hodgkin Lymphoma Undergoing Autologous Stem Cell Transplantation: A Mayo Clinic Cohort Analysis.

Transplant Cell Ther. 2023-3

[4]
Epcoritamab, a Novel, Subcutaneous CD3xCD20 Bispecific T-Cell-Engaging Antibody, in Relapsed or Refractory Large B-Cell Lymphoma: Dose Expansion in a Phase I/II Trial.

J Clin Oncol. 2023-4-20

[5]
Glofitamab for Relapsed or Refractory Diffuse Large B-Cell Lymphoma.

N Engl J Med. 2022-12-15

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Axicabtagene ciloleucel in relapsed or refractory large B-cell lymphoma patients in complete metabolic response.

Haematologica. 2023-4-1

[7]
Low toxicity and excellent outcomes in patients with DLBCL without residual lymphoma at the time of CD19 CAR T-cell therapy.

Blood Adv. 2023-7-11

[8]
Chimeric Antigen Receptor T-Cell Therapies: Barriers and Solutions to Access.

JCO Oncol Pract. 2022-12

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Outcomes of patients with aggressive B-cell lymphoma after failure of anti-CD19 CAR T-cell therapy: a DESCAR-T analysis.

Blood. 2022-12-15

[10]
Positron emission tomography derived metrics in relapsed or refractory large B-cell lymphoma with residual disease before autologous stem cell transplant.

Br J Haematol. 2023-1

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