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autologous stem cell transplantation (ASCT), diffuse large B-cell lymphoma (DLBCL)
Introduction: Autologous stem cell transplantation (ASCT) following high-dose chemotherapy is applied for patients with relapsed/refractory (r/r) DLBCL. However, prognosis of relapsing DLBCL post-ASCT remained poor until the availability of CAR-T cell treatment. To appreciate this development, understanding the outcome of these patients in the pre-CAR-T era is essential.
Methods: We retrospectively analyzed 125 consecutive DLBCL patients who underwent HDCT/ASCT.
Results: After a median follow-up of 26 months, OS and PFS were 65% and 55%. 53 patients (42%) had a relapse (32 patients, 60%) or refractory disease (21 patients, 40%) after a median of 3 months post-ASCT. 81% of relapses occurred within the first year post-ASCT with an OS of 19% versus 40% at last follow-up in patients with later relapses (p=0.0022). Patients with r/r disease after ASCT had inferior OS compared to patients in ongoing remission (23% versus 96%; p<0.0001). Patients relapsing post-ASCT without salvage therapy (n=22) had worse OS than patients with 1-4 subsequent treatment lines (n=31) (OS 0% versus 39%; median OS 3 versus 25 months; p<0.0001). 41 (77%) of patients relapsing after ASCT died, 35 of which due to progression.
Conclusions: Additional therapies can extend OS, but mostly cannot prevent death in DLBCL relapsing/refractory post-ASCT. This study may serve as reference to emerging results after CAR-T treatment in this population.
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