完全缓解期接受治疗的 DLBCL 患者中自体移植 vs. CAR-T 治疗

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.