Introduction: For patients with diffuse large B-cell lymphoma (DLBCL) who achieve partial remission (PR) after salvage chemotherapy, the comparative difference in efficacy between autologous stem cell transplantation (auto-HSCT) and chimeric antigen receptor T-cell (CAR-T) therapy remains unclear. The aim of this study is to evaluate the relative efficacy of auto-HSCT vs CAR-T cell therapy in the retrospective cohort of patients with relapsed/refractory DLBCL who achieve partial remission (PR) with Deauville Score of 4 or 5 after salvage chemotherapy, and to provide evidence for treatment options of this population.

Methods: In a single center retrospective cohort, 35 adult patients (age≥18 years) with relapsed/refractory DLBCL who received auto-HSCT (2021-2024, n=16) or CAR-T cell therapy (2018-2024, n=19) in PR status with Deauville Score of 4 or 5 by positron emission tomography/computed tomography (PET/CT) after second-line or higher salvage chemotherapy were identified. Relevant clinical factors were assessed and there were no significant differences between the two groups at baseline.

Results: The median follow-up time was 16.1 months (range 0.8-67.8). Of the 16 patients who received auto-HSCT, three experienced disease progression but none died, while in the CAR-T therapy group, five experienced disease progression and three of them died ultimately. There were no significant differences in progression-free survival (PFS) (P=0.588) and overall survival (OS) (P=0.106) between patients in the auto-HSCT group and the CAR-T cell therapy group (2-year PFS: 84.6% vs 65.8%; 2-year OS: 100.0% vs 80.2%). Either in the univariable analysis or in the multivariable regression analysis, Deauville Score and the choice of treatment with auto-HSCT or CAR-T cell therapy was not associated with PFS and OS.

Conclusions: In our study cohort, for relapsed/refractory DLBCL that reached PR after salvage therapy, similar PFS and OS were observed in both cohorts of the auto-HSCT and CAR-T cell therapy, regardless of Deauville score of 4 or 5. Although not statistically different, there was a trend toward better OS in the auto-HSCT group. Considering the cost of CAR-T cell therapy product preparation and the clinical risks associated with cytokine release syndrome (CRS), our results suggest the continued clinical significance of auto-HSCT for the treatment of this group of patients by demonstrating real-world outcomes.

Disclosures

No relevant conflicts of interest to declare.

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2024
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