Improved Outcomes with Autologous Stem-Cell Transplantation for LBCL

SAN DIEGO — Autologous stem-cell transplantation (ASCT) led to improved outcomes as compared with CAR T-cell therapy for patients with relapsed large B-cell lymphoma (LBCL) in complete remission, as shown in a retrospective analysis.

Patients who underwent ASCT had fewer relapses at 2 years (27.8% vs 48.0%), and better progression-free survival (PFS, 66.2% vs 47.8%), and overall survival (OS, 78.9% vs 65.6%). In the subgroup of patients with early treatment failure, ASCT was associated with a lower 2-year relapse rate (22.8% vs 45.9%). Treatment-related mortality did not differ between the two types of treatment.

“This data could be practice informing and confirming,” said Mazyar Shadman, MD, of the University of Washington and Fred Hutchinson Cancer Center in Seattle, at the American Society of Hematology (ASH) meeting. “In patients who relapse after first-line therapy after 12 months, the current standard of care is salvage therapy with autotransplant. This data confirms that. There’s currently no data suggesting that patients who are in CR [complete remission] should receive CAR-T therapy in that setting.”

“The goal of therapy should be CAR-T therapy, and all efforts should be made to improve access to CAR-T,” he continued. “Until then, for patients who achieve a good clinical response, an autotransplant [ASCT] strategy could be a reasonable option to discuss … and could add another potentially curative therapy for these patients, knowing that CAR-T could still be utilized in the later line of therapy if autotransplant fails the patient.”

“For patients with primary refractory disease, CAR T-cell therapy is the treatment of choice in the second line. We are not suggesting that these patients should be sent for autotransplant,” Shadman concluded.

The study involved patients who were in CR after initial relapse, as Shadman emphasized. Patients referred for CAR T-cell therapy often receive chemotherapy during the interval when cells are being processed for infusion.

“We don’t expect these patients to respond to subsequent chemotherapy because they have already shown that they don’t do well with chemotherapy,” he said.

Navigate
»  … Read More