Postrelapse survival in diffuse large B-cell lymphoma after therapy failure following autologous transplantation

Narendranath Epperla, Talha Badar, Aniko Szabo, John Vaughn, Steve Borson, Neeraj Y. Saini, Romil D. Patel, Nirav N. Shah, Mehdi Hamadani, Sairah Ahmed, Amanda F. Cashen, Timothy S. Fenske

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19 Scopus citations


Outcomes for diffuse large B-cell lymphoma (DLBCL) patients relapsing after autologous hematopoietic cell transplantation (auto-HCT) have been historically poor. We studied outcomes of such patients using data from 4 transplantation centers. Eligibility criteria included adult patients (age $18 years) with DLBCL experiencing disease relapse after auto- HCT performed during 2006 to 2015. The time period was stratified into 2 eras (era 1, 2006- 2010; era 2, 2011-2015). The primary end point was postrelapse overall survival (PR-OS). Secondary end points were factors prognostic of PR-OS. Of the 700 patients with DLBCL who underwent auto-HCT, 248 (35%) relapsed after auto-HCT. Median PR-OS of all relapsed DLBCL patients after auto-HCT (n 5 228) was 9.8 months (95% confidence interval [CI], 7-15). Median PR-OS was significantly better for patients in complete (17.8 months; 95% CI, 7.9- 41.6) vs partial remission at auto-HCT (7.1 months; 95% CI, 5.4-11; P 5 .01), those undergoing auto-HCT .1 year (12.8 months; 95% CI, 7.6-24.9) vs #1 year after DLBCL diagnosis (6.3 months; 95% CI, 4.5-9.2; P 5 .01), and those with late (56.4 months; 95% CI, 23.7-') vs early relapse (5.9 months; 95% CI, 4.5-8.8; P , .0001). On multivariate analysis, although late relapse (hazard ratio [HR], 0.21; 95% CI, 0.13-0.34; P , .0001) was associated with significantly lower mortality, the risk of mortality increased with age (HR, 1.25 per decade; 95% CI, 1.06-1.48; P 5 .009). This is the largest study to date to evaluate outcomes of DLBCL patients relapsing after auto-HCT. Our study provides benchmarking for future trials of chimeric antigen receptor T cells and other promising agents evaluating PR-OS after auto-HCT.

Original languageEnglish
Pages (from-to)1661-1669
Number of pages9
JournalBlood Advances
Issue number11
StatePublished - Jun 11 2019


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