Allogeneic transplant and CAR-T therapy after autologous transplant failure in DLBCL: a noncomparative cohort analysis
Abstract
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.
Document Details
- Document Type
- Pub Defense Publication
- Publication Date
- Jan 18, 2022
- Source ID
- 10.1182/bloodadvances.2021005788
Entities
People
- Ajay K. Gopal
- Aleksandr Lazaryan
- Andrew Daly
- Dipenkumar Modi
- Frederick L. Locke
- Hamza Hashmi
- Jordan Gauthier
- Lazaros Lekakis
- Marcelo C Pasquini
- Megan M. Herr
- Mehdi Hamadani
- Natalie S Grover
- P. Connor Johnson
- Parastoo Bahrami Dahi
- Peiman Hematti
- Premal Lulla
- Sairah Ahmed
- Soyoung Kim
- Stefan O Ciurea
- Vaibhav Agrawal
- Vijaya Raj Bhatt
- Xianmiao Qiu
Organizations
- Baylor College of Medicine
- Fred Hutchinson Cancer Center
- H. Lee Moffitt Cancer Center & Research Institute
- Massachusetts General Hospital
- Medical College of Wisconsin
- Medical University of South Carolina
- Roswell Park Comprehensive Cancer Center
- Stanford University
- University of California
- University of Miami
- University of Nebraska–Lincoln
- University of North Carolina
- University of Texas at Austin
- University of Washington
- University of Wisconsin–Madison
- Wayne State University