https://orcid.org/0000-0001-9929-8617
Key Points
Our results indicate that ASCT is a curative option for patients with chemosensitive disease especially in CR after salvage.
ASCT could be still considered in patients with primary refractory or early relapse in centers with limited access to CAR-T therapy.
We performed a retrospective multicenter study including 791 patients with relapsed/refractory (R/R) large B cell lymphoma (LBCL) who underwent ASCT from 2010-2021. All the patients received rituximab and anthracycline-based frontline therapy. After a median follow-up of 74 months (95%CI 68-81) from infusion, 65% of the patients were alive and 84% of them free of disease. Progression-free survival (PFS) and overall survival (OS) at 6 years were 51% (95%CI 47-54) and 63% (95%CI 60-67), respectively. Non-relapse mortality (NRM) at 1 year was 9% (95%CI 7-11). Age >60 years at ASCT [HR 1.31 (95%CI 1.06-1.62), p=0.011], ASCT as ≥3rd line [HR 1.81 (95%CI 1.42-2.31), p<0.001] and partial response (PR) versus complete response (CR) at ASCT [HR 1.46 (95%CI 1.18-1.81), p<0.001] were the independent variables influencing PFS. Age >60 years at ASCT [HR 1.62 (95%CI 1.24-2.12), p<0.001], time period before first of November 2012 [HR 1.40 (95%CI 1.07-1.83), p=0.014], ASCT as ≥3rd line [HR 1.77 (95%CI 1.32-2.37), p<0.001], PR versus CR [HR 1.58 (95%CI 1.22-2.05), p<0.001] and stable disease (SD) versus CR pre-ASCT [HR 3.41 (95%CI 1.81-6.45), p<0.001] were the variables associated with worse OS. Refractory or early relapse did not significantly influence survival (6y-PFS and OS in patients with refractory, early and late relapse was 54% and 64%; 46% and 62% and 49% and 63%, respectively). To our knowledge, this is the largest series analyzing the efficacy of ASCT in patients with R/R LBCL after rituximab-containing frontline therapy. Our results indicate that ASCT is a curative option for patients with chemosensitive disease.
