Page 177 - Haematologica Vol. 109 - July 2024

ARTICLE - ASCT in refractory or early relapsed DLBCL A.M. Tun et al. AB
CD
Figure 2. Post-autologous stem cell transplant outcomes according to refractory and/or time to relapse status and line of sal- vage chemotherapy. (A) Progression-free survival and (B) overall survival by refractory and/or time to relapse status. (C) Progres- sion-free survival and (D) overall survival by line of salvage chemotherapy. PFS: progression-free survival; ASCT: autologous stem cell transplant; ST: salvage chemotherapy; OS: overall survival.
PFS, 52%) and 71.1 months (24-month PFS, 62%), respec- tively. Most importantly, survival outcomes were excellent in patients who had only one line of ST and resulted in CR, with their median PFS being 88.5 months (24-month PFS, 65%). These findings imply that HDT, followed by ASCT rescue, confers complete eradication of lymphoma cells that are biologically sensitive to chemotherapy.
In patients who achieved PR after one line of ST, our study showed that the median PFS was 9.1 months, with the 24-month PFS rate being 39%. The CIBMTR study found a 5-year post-ASCT PFS rate of 41% in patients with failure of early frontline immunochemotherapy (i.e. primary refrac- tory disease or relapse within 12 months of diagnosis).12 A similar result was documented in the MD Anderson Cancer Center with a 5-year post-ASCT PFS rate of 40% in pa- tients with relapsed or refractory DLBCL who had residual
disease before ASCT.26 Variations in survival rates among these studies are due, in part, to different study popula- tions, study eras, patterns of relapse, and management approaches.12,26 In addition, the definition of PR by treating physicians is subjective, and varies depending on imaging modality (i.e., computed tomography alone or with positron emission tomography).27 Nevertheless, despite achieving only PR, their survival outcomes after ASCT are reasonable, with a long-term remission rate of ~40%, supporting the role of ASCT consolidation.12,26 In the CAR-T therapy era, the role of ASCT consolidation in patients achieving PR to ST was reported by the CIBMTR.28 In this study, the efficacy of ASCT was compared with that of axicabtagene ciloleucel in a total of 411 patients of whom 266 undergoing ASCT consolidation and 145 receiving axicabtagene ciloleucel.28 The study found that ASCT consolidation, compared to
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