title: Allogeneic transplantation provides durable remission in a subset of DLBCL patients relapsing after autologous transplantation.
abstract: For diffuse large B-cell lymphoma (DLBCL) patients progressing after autologous haematopoietic cell transplantation (autoHCT), allogeneic HCT (alloHCT) is often considered, although limited information is available to guide patient selection. Using the Center for International Blood and Marrow Transplant Research (CIBMTR) database, we identified 503 patients who underwent alloHCT after disease progression/relapse following a prior autoHCT. The 3-year probabilities of non-relapse mortality, progression/relapse, progression-free survival (PFS) and overall survival (OS) were 30, 38, 31 and 37% respectively. Factors associated with inferior PFS on multivariate analysis included Karnofsky performance status (KPS) <80, chemoresistance, autoHCT to alloHCT interval <1-year and myeloablative conditioning. Factors associated with worse OS on multivariate analysis included KPS<80, chemoresistance and myeloablative conditioning. Three adverse prognostic factors were used to construct a prognostic model for PFS, including KPS<80 (4 points), autoHCT to alloHCT interval <1-year (2 points) and chemoresistant disease at alloHCT (5 points). This CIBMTR prognostic model classified patients into four groups: low-risk (0 points), intermediate-risk (2-5 points), high-risk (6-9 points) or very high-risk (11 points), predicting 3-year PFS of 40, 32, 11 and 6%, respectively, with 3-year OS probabilities of 43, 39, 19 and 11% respectively. In conclusion, the CIBMTR prognostic model identifies a subgroup of DLBCL patients experiencing long-term survival with alloHCT after a failed prior autoHCT.
authors.affiliation: Froedtert Memorial Lutheran Hospital, Milwaukee, WI, USA.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Fenske
authors.affiliation: Department of Medicine, CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA.|Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Kwang W
authors.initials: KW
authors.lastname: Ahn
authors.affiliation: Medical Oncology Hematology Associates, Des Moines, IA, USA.
authors.forename: Tara M
authors.initials: TM
authors.lastname: Graff
authors.affiliation: Department of Medicine, CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Alyssa
authors.initials: A
authors.lastname: DiGilio
authors.affiliation: Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Qaiser
authors.initials: Q
authors.lastname: Bashir
authors.affiliation: Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Rammurti T
authors.initials: RT
authors.lastname: Kamble
authors.affiliation: Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Ayala
authors.affiliation: Department of Haematology/Oncology, University Medicine Goettingen, Goettingen, Germany.|Interdisciplinary Clinic for Stem Cell Transplantation, University Cancer Centre Hamburg, Hamburg, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Bacher
authors.affiliation: Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Brammer
authors.affiliation: Department of Pediatrics, Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, New York Medical College, Valhalla, NY, USA.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Cairo
authors.affiliation: Center for Hematologic Malignancies, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Andy
authors.initials: A
authors.lastname: Chen
authors.affiliation: Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Yi-Bin
authors.initials: YB
authors.lastname: Chen
authors.affiliation: Division of Hematology/Oncology, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Chhabra
authors.affiliation: Department of Medicine, CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: D'Souza
authors.affiliation: Department of Oncology and Blood Marrow Transplantation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors.forename: Umar
authors.initials: U
authors.lastname: Farooq
authors.affiliation: South Texas Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, TX, USA.
authors.forename: Cesar
authors.initials: C
authors.lastname: Freytes
authors.affiliation: Blood and Marrow Transplantation, Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Ganguly
authors.affiliation: Department of Haematology, Prince of Wales Hospital, Randwick, NSW, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Hertzberg
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, MN, USA.
authors.forename: David
authors.initials: D
authors.lastname: Inwards
authors.affiliation: Division of Hematology, The Ohio State University Medical Center, Columbus, OH, USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Jaglowski
authors.affiliation: Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Kharfan-Dabaja
authors.affiliation: Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.affiliation: Department of Hematology, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Sunita
authors.initials: S
authors.lastname: Nathan
authors.affiliation: Department of Internal Medicine, Blood and Marrow Transplantation Program, Division of Hematology/Oncology, The University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Attaphol
authors.initials: A
authors.lastname: Pawarode
authors.affiliation: Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Miguel-Angel
authors.initials: MA
authors.lastname: Perales
authors.affiliation: Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Nishitha
authors.initials: N
authors.lastname: Reddy
authors.affiliation: Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Sachiko
authors.initials: S
authors.lastname: Seo
authors.affiliation: Servei d'Hematologia, Institut Catala d'Oncologia, Hospital Duran I Reynals, Barcelona, Spain.|European Group for Blood and Marrow Transplantation, Barcelona, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Sureda
authors.affiliation: Section of Hematology/Oncology, The University of Chicago, Chicago, IL, USA.
authors.forename: Sonali M
authors.initials: SM
authors.lastname: Smith
authors.affiliation: Froedtert Memorial Lutheran Hospital, Milwaukee, WI, USA.|Department of Medicine, CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Hamadani
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D018572:Disease-Free Survival; D004351:Drug Resistance; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction / Q000379:methods; D018570:Risk Assessment / Q000706:statistics & numerical data; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000379:methods; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019653:Myeloablative Agonists
keywords: DLBCL; allogeneic transplantation; prior autologous transplan; prognostic score