Allogeneic transplant and CAR-T therapy after autologous transplant failure in DLBCL: a noncomparative cohort analysis. Blood Adv 2022 Jan 25;6(2):486-494
Date
10/22/2021Pubmed ID
34673903Pubmed Central ID
PMC8791562DOI
10.1182/bloodadvances.2021005788Scopus ID
2-s2.0-85123544420 (requires institutional sign-in at Scopus site) 24 CitationsAbstract
Allogeneic transplant (alloHCT) and chimeric antigen receptor modified (CAR)-T cell therapy are potentially cuarative options of diffuse large B-cell lymphoma (DLBCL) relapsing after an autologous (auto)HCT. Although the Center for International Blood and Marrow Transplant Research (CIBMTR) prognostic model can predict outcomes of alloHCT in DLBCL after autoHCT failure, corresponding models of CAR-T treatment in similar patient populations are not available. In this noncomparative registry analysis, we report outcomes of patients with DLBCL (≥18 years) undergoing a reduced intensity alloHCT or CAR-T therapy with axicabtagene ciloleucel during 2012 to 2019 after a prior auto-HCT failure and apply the CIBMTR prognostic model to CAR-T recipients. A total of 584 patients were included. The 1-year relapse, nonrelapse mortality, overall survival (OS), and progression-free survival for CAR-T treatment after autoHCT failure were 39.5%, 4.8%, 73.4%, and 55.7%, respectively. The corresponding rates in the alloHCT cohort were 26.2%, 20.0%, 65.6%, and 53.8%, respectively. The 1-year OS of alloHCT recipients classified as low-, intermediate- and high/very high-risk groups according to the CIBMTR prognostic score was 73.3%, 59.9%, and 46.3%, respectively (P = .002). The corresponding rates for low-, intermediate-, and high/very high-risk CAR-T patients were 88.4%, 76.4%, and 52.8%, respectively (P < .001). This registry analysis shows that both CAR-T and alloHCT can provide durable remissions in a subset of patients with DLBCL relapsing after a prior autoHCT. The simple CIBMTR prognostic score can be used to identify patients at high risk of treatment failure after either procedure. Evaluation of novel relapse mitigations strategies after cellular immunotherapies are warranted in these high-risk patients.
Author List
Hamadani M, Gopal AK, Pasquini M, Kim S, Qiu X, Ahmed S, Lazaryan A, Bhatt VR, Daly A, Lulla P, Ciurea S, Gauthier J, Agrawal V, Grover NS, Lekakis L, Modi D, Dahi PB, Herr MM, Johnson PC, Hashmi H, Hematti P, Locke FLAuthors
Mehdi H. Hamadani MD Professor in the Medicine department at Medical College of WisconsinPeiman Hematti MD Professor in the Medicine department at Medical College of Wisconsin
Soyoung Kim PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Marcelo C. Pasquini MD, MS Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AllograftsAutografts
Cohort Studies
Hematopoietic Stem Cell Transplantation
Humans
Lymphoma, Large B-Cell, Diffuse
Neoplasm Recurrence, Local