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