ArticleAnnals of hematology2025
Autologous stem cell transplantation from 2011 to 2022 in Japanese patients aged ≥ 65 years with relapsed or refractory diffuse large B-cell lymphoma.
Article in Annals of hematology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
High-dose chemotherapy with autologous stem cell transplantation (ASCT) is an option for patients aged ≥ 65 years with relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL). Few data are available to select patients suitable for chimeric antigen receptor T-cell (CAR-T) therapy or bispecific antibodies. We retrospectively analyzed the risk factors for poor outcomes for 451 Japanese patients aged ≥ 65 years with R/R DLBCL who received ASCT at either second complete remission or first partial remission (n = 336 and 115, respectively) between 2011 and 2022. CAR-T became commercially available in Japan in March 2019, and the annual number of ASCTs for older patients with R/R DLBCL increased significantly until 2018. However, the number of ASCT cases plateaued in 2018. Multivariate Cox regression analysis identified ≤ 24 months from diagnosis to ASCT (hazard ratio [HR], 1.497) and performance status > 0 at ASCT (HR, 1.460) as independent predictors of overall survival (OS) and an association with late recurrence. The 3-year OS rates were 73.4% (95% confidence interval [CI], 65.8%-79.6%) in patients with > 24 months from diagnosis to ASCT and 58.6% (95% CI, 51.2%-65.2%) in those with ≤ 24 months from diagnosis to ASCT. The 3-year OS rates were 69.4% (95% CI, 62.5%-75.2%) in patients with performance status (PS) = 0 and 60.6% (95% CI, 62.5%-70.4%) in those with PS > 0. CAR-T therapy or bispecific antibodies may be used initially instead of ASCT for early relapsed and refractory patients. However, ASCT remains beneficial for older chemo-sensitive patients with late recurrence and good performance status.
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