In patients with relapsed DLBCL in complete remission (CR), autologous hematopoietic cell transplantation (auto-HCT) and CAR-T therapy are both effective, but it is unknown which modality provides superior outcomes. We compared the efficacy of auto-HCT vs. CAR-T in patients with DLBCL in a CR. A retrospective observational study comparing auto-HCT (2015–2021) vs. CAR-T (2018–2021) using the Center for International Blood & Marrow Transplant Research registry. Median follow-up was 49.7 months for the auto-HCT and 24.7 months for the CAR-T cohort. Patients ages 18 and 75 with a diagnosis of DLBCL were included if they received auto-HCT (n = 281) or commercial CAR-T (n = 79) while in a CR. Patients undergoing auto-HCT with only one prior therapy line and CAR-T patients with a previous history of auto-HCT treatment were excluded. Endpoints included Progression-free survival (PFS), relapse rate, non-relapse mortality (NRM) and overall survival (OS). In univariate analysis, treatment with auto-HCT was associated with a higher rate of 2-year PFS (66.2% vs. 47.8%; p < 0.001), a lower 2-year cumulative incidence of relapse (27.8% vs. 48% ; p < 0.001), and a superior 2-year OS (78.9% vs. 65.6%; p = 0.037). In patients with early (within 12 months) treatment failure, auto-HCT was associated with a superior 2-year PFS (70.9% vs. 48.3% ; p < 0.001), lower 2-year cumulative incidence of relapse (22.8% vs. 45.9% ; p < 0.001) and trend for higher 2-year OS (82.4% vs. 66.1% ; p = 0.076). In the multivariable analysis, treatment with auto-HCT was associated with a superior PFS (hazard ratio 1.83; p = 0.0011) and lower incidence of relapse (hazard ratio 2.18; p < 0.0001) compared to CAR-T. In patients with relapsed LBCL who achieve a CR, treatment with auto-HCT is associated with improved clinical outcomes compared to CAR-T. These data support the consideration of auto-HCT in select patients with LBCL achieving a CR in the relapsed setting.
对于达到完全缓解（CR）的复发性弥漫性大B细胞淋巴瘤（DLBCL）患者，自体造血细胞移植（auto-HCT）与CAR-T疗法均有效，但尚不清楚哪种方案能提供更优的疗效。本研究比较了达到CR的DLBCL患者接受auto-HCT与CAR-T治疗的疗效。我们利用国际血液与骨髓移植研究中心登记处的数据，开展了一项回顾性观察研究，比较了auto-HCT（2015–2021年）与CAR-T（2018–2021年）治疗的效果。auto-HCT组的中位随访时间为49.7个月，CAR-T组为24.7个月。研究对象为年龄在18至75岁之间、诊断为DLBCL且在CR状态下接受auto-HCT（n=281）或商业化CAR-T（n=79）治疗的患者。排除了仅接受过一线治疗即进行auto-HCT的患者，以及有auto-HCT治疗史的CAR-T患者。研究终点包括无进展生存期（PFS）、复发率、非复发死亡率（NRM）和总生存期（OS）。单变量分析显示，auto-HCT治疗与更高的2年PFS率（66.2% vs. 47.8%；p<0.001）、更低的2年累积复发率（27.8% vs. 48%；p<0.001）以及更优的2年OS率（78.9% vs. 65.6%；p=0.037）相关。在早期（12个月内）治疗失败的患者中，auto-HCT与更优的2年PFS率（70.9% vs. 48.3%；p<0.001）、更低的2年累积复发率（22.8% vs. 45.9%；p<0.001）以及更高的2年OS趋势（82.4% vs. 66.1%；p=0.076）相关。在多变量分析中，与CAR-T相比，auto-HCT治疗与更优的PFS（风险比1.83；p=0.0011）和更低的复发率（风险比2.18；p<0.0001）相关。对于达到CR的复发性LBCL患者，与CAR-T相比，auto-HCT治疗与更佳的临床结局相关。这些数据支持在复发背景下达到CR的LBCL患者中，考虑对特定患者选择auto-HCT治疗。
Autologous transplant vs. CAR-T therapy in patients with DLBCL treated while in complete remission
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