title: Autologous stem cell transplantation for relapsed/refractory diffuse large B-cell lymphoma: efficacy in the rituximab era and comparison to first allogeneic transplants. A report from the EBMT Lymphoma Working Party.
abstract: In the era of chemoimmunotherapy, the optimal treatment paradigm for relapsed and refractory diffuse large B-cell lymphoma has been challenged. We reviewed the outcome of standard salvage therapy with an autologous stem cell transplant (autoSCT) over the last two decades and the outcome of allogeneic SCT (alloSCT) in the most recent decade. AutoSCT recipients diagnosed between 1992 and 2002 (n=2737) were compared with those diagnosed between 2002 and 2010 (n=3980). Patients diagnosed after 2002 had a significantly lower non-relapse mortality (NRM) and relapse incidence (RI) and a superior PFS and overall survival (OS). A total of 4210 patients diagnosed between 2002 and 2010 underwent either an autoSCT or an alloSCT as their first transplant procedure. Two-hundred and thirty patients received an alloSCT (myeloablative (MACalloSCT) n=132, reduced intensity (RICalloSCT) n=98). The 4-year NRM rates were 7%, 20% and 27% for autoSCT, RICalloSCT and MACalloSCT, respectively. The 4-year RI was 45%, 40% and 38% for autoSCT, RICalloSCT and MACalloSCT, respectively (NS). The 4-year PFS were 48%, 52% and 35% for autoSCT, RICalloSCT and MACalloSCT, respectively. The 4-year OS was 60%, 52% and 38% for autoSCT, RIC alloSCT and MACalloSCT, respectively. After adjustment for confounding factors NRM was significantly worse for patients undergoing alloSCT whilst there was no difference in the RI.
authors.affiliation: Department of Haematology, University Hospital Bristol NHS Foundation Trust, Bristol, UK.
authors.forename: S P
authors.initials: SP
authors.lastname: Robinson
authors.affiliation: Lymphoma Working Party, EBMT, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Boumendil
authors.affiliation: Lymphoma Working Party, EBMT, Paris, France.
authors.forename: H
authors.initials: H
authors.lastname: Finel
authors.affiliation: Program de Transplantation and Therapie Cellulaire, Institut Paoli Calmettes, Marseille, France.
authors.forename: D
authors.initials: D
authors.lastname: Blaise
authors.affiliation: Department of Haematology, Cliniques Universitaires St. Luc, Brussels, Belgium.
authors.forename: X
authors.initials: X
authors.lastname: Poiré
authors.affiliation: Department of Haematology, Centre Leon Berard, Lyon, France.
authors.forename: E
authors.initials: E
authors.lastname: Nicolas-Virelizier
authors.affiliation: Department of BMT, Hadassah University Hospital, Jerusalem, Israël.
authors.forename: R
authors.initials: R
authors.lastname: Or
authors.affiliation: Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: R
authors.initials: R
authors.lastname: Malladi
authors.affiliation: Services des Maladies du Sang, CHU, Angers, France.
authors.forename: A
authors.initials: A
authors.lastname: Corby
authors.affiliation: Department of Haematology, Nouvel Hopital Civil, Strasbourg, France.
authors.forename: L
authors.initials: L
authors.lastname: Fornecker
authors.affiliation: Servicio de Haematogica, Hospital Clínico, Salamanca, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Caballero
authors.affiliation: Department of Medicine, Charles University Hospital, Prague, Czech Republic.
authors.forename: D
authors.initials: D
authors.lastname: Pohlreich
authors.affiliation: Department of Haematology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Nagler
authors.affiliation: APHP Hemato-Oncology Department, Saint-Louis Hospital, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Thieblemont
authors.affiliation: Department of Medicine, University of Freiburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Finke
authors.affiliation: Department of Haematology, Hospices Civils de Lyon, Pierre-Benite, France.
authors.forename: E
authors.identifier: http://orcid.org/0000-0003-2694-7510
authors.initials: E
authors.lastname: Bachy
authors.affiliation: Department d'Hematologie Clinique, CHU Lapeyronie, Montpellier, France.
authors.forename: L
authors.identifier: http://orcid.org/0000-0001-5904-1286
authors.initials: L
authors.lastname: Vincent
authors.affiliation: Department of Haematology, Antwerp University Hospital (UZA), Antwerp Edegem, Belgium.
authors.forename: W
authors.initials: W
authors.lastname: Schroyens
authors.affiliation: Department of Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Schouten
authors.affiliation: Medizinische Klinik, University Of Heidelberg, Heidelberg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Dreger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064592:Autografts; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D000069283:Rituximab / Q000008:administration & dosage*; D033581:Stem Cell Transplantation; D015996:Survival Rate
chemical_list: D000069283:Rituximab