van der Galiën Hilde T, Kooistra Hilde A M, Kibbelaar Robby, Veeger Nic J G M, Nijland Marcel, Huls Gerwin, van Meerten Tom, van Rijn Rozemarijn S
Department of Hematology, Frisius MC, Leeuwarden, the Netherlands.
Department of Hematology, University Medical Center Groningen, Groningen, the Netherlands.
Eur J Haematol. 2025 Oct;115(4):391-402. doi: 10.1111/ejh.70003. Epub 2025 Jul 9.
Chimeric antigen receptor T-cell therapy (CART) has replaced salvage immunochemotherapy followed by high-dose chemotherapy and autologous stem cell transplantation (HDT-ASCT) as the preferred second-line treatment for early relapsed (< 12 months) large B-cell lymphoma (LBCL). However, for patients with a late relapse (> 12 months), CART is inaccessible until third line. We analyzed 877 patients from the HemoBase registry (diagnosed 2005-2020) to assess differences in long-term outcomes of early versus late relapse in second line. Early relapse occurred in 120/654 patients (18%) who completed first-line treatment, with 2- and 5-year overall survival (OS) of 22% and 18%. Late relapse occurred in 70 patients (11%), showing slightly better 2-year OS of 36% but similarly poor 5-year OS of 20%. Only 13% of early and 16% of late relapsed patients completed HDT-ASCT, achieving 5-year OS of 71% and 49%, respectively. Most patients initiating salvage immunochemotherapy did not reach HDT-ASCT and had dismal survival (5-year OS 8% early, 18% late), comparable to HDT-ASCT-ineligible patients (10% early, 14% late). These real-world data highlight poor outcomes with previous second-line therapies and support alternative strategies like CART in second line for patients with both early relapsing (< 12 months) and late relapsing (> 12 months) LBCL.
嵌合抗原受体T细胞疗法（CART）已取代挽救性免疫化疗，随后进行大剂量化疗和自体干细胞移植（HDT-ASCT），成为早期复发（<12个月）的大B细胞淋巴瘤（LBCL）二线治疗的首选方案。然而，对于晚期复发（>12个月）的患者，直到三线治疗时才能使用CART。我们分析了HemoBase注册中心的877例患者（2005年至2020年诊断），以评估二线治疗中早期复发与晚期复发患者长期预后的差异。120/654例（18%）完成一线治疗的患者出现早期复发，其2年和5年总生存率（OS）分别为22%和18%。70例患者（11%）出现晚期复发，其2年总生存率略好，为36%，但5年总生存率同样较差，为20%。只有13%的早期复发患者和16%的晚期复发患者完成了HDT-ASCT，其5年总生存率分别为71%和49%。大多数开始挽救性免疫化疗的患者未接受HDT-ASCT，生存情况不佳（早期5年总生存率为8%，晚期为18%），与不符合HDT-ASCT条件的患者相当（早期为10%，晚期为14%）。这些真实世界的数据凸显了既往二线治疗的不良预后，并支持在二线治疗中对早期复发（<12个月）和晚期复发（>12个月）的LBCL患者采用CART等替代策略。
