Biol Blood Marrow Transplant. 2020 Sep 16:S1083-8791(20)30591-7. doi: 10.1016/j.bbmt.2020.09.004. Online ahead of print.
Outcomes of patients with primary refractory diffuse large B cell lymphoma (DLBCL) are dismal. The role of autologous hematopoietic cell transplant (autoHCT) in this population is not well defined in the modern era. Most datasets combine these patients with those with relapsed disease. We report the outcomes of autoHCT in patients with primary refractory DLBCL that subsequently demonstrated chemosensitive disease with salvage therapies, using the Center for International Blood and Marrow
Transplant Research (CIBMTR) registry. Between 2003 and 2018, 169 patients met the inclusion criteria. The median age of the cohort was 54 years, 64% were male. The patients had advanced stage disease (73%) at diagnosis, 27% patients had stable disease and 73% had progressive disease after frontline chemoimmunotherapy. Following salvage therapy, 36% patients were in complete remission (CR) and 64% in partial remission (PR). Non-relapse mortality (NRM), progression/relapse, progression-free survival (PFS) and overall survival (OS) of this cohort at 4-years was 10.8% (95%CI 6-13), 47.8% (95%CI 41-52), 41.4% (95%CI 38-50) and 49.6% (95 CI 44-56), respectively. On univariate analysis, patients with progressive disease after frontline chemoimmunotherapy did just as well as those with stable disease. Patients achieving CR with salvage therapy had a lower cumulative incidence of progression/relapse at one year (30% vs 46.9%; p=0.02) and experienced superior one-year PFS compared to patients in PR (63.2% vs 46.7%; p=0.03). AutoHCT provides durable disease control and should remain the standard-of-care in primary refractory DLBCL patients who respond to salvage therapies.