自体移植或 CAR-T 作为挽救治疗后缓解的 MYC 重排大 B 细胞淋巴瘤患者的巩固治疗选择

Although recent studies have demonstrated the efficacy of chimeric antigen receptor T-cell (CAR-T) therapy in relapsed large B-cell lymphoma (LBCL) with MYC rearrangement (R-MYC), the data comparing CAR-T to autologous hematopoietic cell transplant (auto-HCT) in such patients who achieve a complete or partial response (CR/PR) after salvage therapies are limited.

We compared the clinical outcomes of patients with R-MYC LBCL (including double and triple hit lymphomas) who underwent CAR-T or auto-HCT after achieving a CR/PR with salvage therapies using the Center for International Blood & Marrow Transplant Research registry. Among the 252 patients (auto-HCT = 98, CAR-T = 154), relative to auto-HCT, CAR-T was associated with significantly lower overall survival (OS) (Hazard Ratio [HR] 2. 09, 95% CI 1. 38-3. 15, p < 0. 001) on multivariate analysis. There were no differences in progression-free survival (PFS) (HR 1. 21, 95% CI 0. 81-1. 8 p = 0. 36), risk of relapse (HR 1. 1, 95% CI 0. 71-1. 69 p = 0. 68), nonrelapse mortality (NRM) (HR 1. 74, 95% CI 0. 64-4. 7 p = 0.

28) while the post-relapse survival was longer in auto-HCT relative to CAR-T (HR 1. 93, 95% CI 1. 21-3. 06 p = 0. 01). On propensity score matched analysis accounting for differences in characteristics across the two cohorts, we detected no significant differences in OS (HR 1. 72, 95% CI 0. 92-3. 21 p = 0. 09), PFS (HR 1. 04, 95% CI 0. 64-1. 68 p = 0. 88), NRM (HR 1.

22, 95% CI 0. 35-4. 2 p = 0. 76), relapse (HR = 0. 93, 95% CI 0. 54-1. 6 p = 0. 8) and post-relapse survival (HR 2. 25, 95% CI 0. 98-5. 17, p = 0. 06). These data, although retrospective, support consideration for auto-HCT in patients with R-MYC LBCL who achieve a CR/PR after salvage therapies, particularly in regions with no or limited access to CAR-T.