Page 175 - Haematologica Vol. 109 - July 2024

ARTICLE - ASCT in refractory or early relapsed DLBCL A.M. Tun et al. AB
CD
Figure 1. Outcomes after autologous stem cell transplantation in patients with refractory or early relapsed diffuse large B-cell lymphoma. (A) Progression-free survival. (B) Overall survival. (C) Cumulative incidence of relapse and non-relapse mortality. (D) Cumulative incidence of deaths divided by cause. PFS: progression-free survival; ASCT: autologous stem cell transplant; OS: overall survival.
D, Table 2). In multivariate Cox regression models adjust- ed for age at ASCT and sex, lines of ST and response to ST before ASCT remained prognostic for PFS (1 line of ST: hazard ratio [HR]=0.53, 95% CI: 0.36-0.77; P=0.0008 and CR: HR=0.49, 95% CI: 0.35-0.69; P<0.0001) and OS (1 line of ST: HR=0.51, 95% CI: 0.35-0.74; P=0.0005 and CR: HR=0.46, 95% CI: 0.32-0.66; P<0.0001). Additionally, in this multivar- iate model, time to first relapse/refractory status (relapse between 6-12 months vs. refractory or relapse <6 months after frontline therapy) showed a trend for improvement in PFS (HR=0.83, 95% CI: 0.59-1.18; P=0.31) and a statistically significant improvement in OS (HR=0.67, 95% CI: 0.46-0.98; P=0.04) (Online Supplementary Table S6).
Note that patients with a MYC rearrangement, compared to those without, had significantly inferior PFS (median PFS 3.1 vs. 43.3 months; P=0.0001) and OS (median OS 6.2
vs. 67.4 months; P<0.0001) (Table 2, Online Supplementary Figure S3).
Discussion
The new standard of care in fit patients with primary refractory or early relapsed DLBCL occurring within 12 months of completing frontline immunochemotherapy is CAR-T therapy with axicabtagene ciloleucel or lisocabta- gene maraleucel according to the results of the contem- porary ZUMA-7 and TRANSFORM studies.15,17 Our study of such patients, treated with ST and ASCT, documented reasonable survival outcomes with a median PFS of 16.1 months and the 24-month PFS of 47%. The results from our study are in keeping with those of the CIBMTR that
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