Role of allogeneic hematopoietic cell transplant for relapsed/refractory aggressive B-cell lymphomas in the CART era
Por:
Mussetti, A, Bento, L, Bastos-Oreiro, M, Sansalvador, BR, Albo, C, Bailen, R, Barba, P, Benzaquen, A, Briones, J, Caballero, AC, Campos, A, Espanol, I, Ferra, C, Lopez, SG, Sierra, PAG, Guerra, LM, Hernani, R, Iacoboni, G, Ubieto, AIJ, Kwon, M, Corral, LL, Lopez-Godino, O, Munoz, MCM, Martinez-Cibrian, N, Gomez, JM, Perez-Ortega, L, Ortf, G, Ortiz-Maldonado, V, Pascual, MJ, Perera, M, Perez, A, Reguera, JL, Sanchez, JM, Sanz, J, Torrent, A, Yanez, L, Varela, R, Echechipia, IC, Caballero, D and Sureda, A
Publicada:
1 jun 2023
Ahead of Print:
1 mar 2023
Resumen:
Anti-CD19 chimeric antigen receptor T cells (CART) has rapidly been adopted as the standard third-line therapy to treat aggressive B-cell lymphomas (ABCL) after failure of second-line therapy despite the lack of direct comparisons with allogeneic hematopoietic cell transplantation (alloHCT)-based strategies. Using the Grupo Espanol de Trasplante y Terapia Celular (GETH-TC) registry, we selected patients with the following characteristics: CART or alloHCT performed between 2016 and 2021; >= 18 years old; ABCL diagnosis; >= 2 lines of therapy; and either anti-CD19 CART or alloHCT as therapy at relapse. The analysis included a total of 316 (CART =215, alloHCT = 101) patients. Median follow-up was 15 and 36 months for the CART and alloHCT cohorts, respectively. In the multivariate analysis, CART was confirmed to be similar to alloHCT for the primary study endpoint (progression-free survival) (hazard ratio [HR] 0.92, CI95%:0.56-1.51, p= 0.75). Furthermore, when the analysis was limited to only patients with chemosensitive diseases (complete and partial response) at infusion (CART = 26, alloHCT=93), no differences were reported (progression free survival at month +18:65% versus 55%, p = 0.59). However, CART had lower non-relapse mortality (HR 0.34, 95% CI: 0.13-0.85, p = 0.02). Given the lower toxicity and similar survival outcomes, these results suggest the use of CART before alloHCT. Bone Marrow Transplantation
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