Autologous and allogeneic hematopoietic cell transplantation for diffuse large B-cell lymphoma–type Richter syndrome
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Richter syndrome (RS) represents a transformation from chronic lymphocytic leukemia/ small lymphocytic lymphoma (CLL/SLL) to aggressive lymphoma, most commonly diffuse large B-cell lymphoma (DLBCL), which is associated with a dismal prognosis. Patients with DLBCL-RS have poor outcomes with DLBCL-directed therapy; thus, consolidation with hematopoietic cell transplantation (HCT) has been used, with durable remissions observed. Studies reporting HCT outcomes in patients with DLBCL-RS have been small, have not evaluated the prognostic impact of cytogenetic risk factors, and were conducted prior to the era of novel targeted therapy of CLL/SLL. We performed a Center for International Blood and Transplant Research registry study evaluating outcomes after autologous HCT (auto-HCT; n 5 53) and allogeneic HCT (allo-HCT; n 5 118) in patients with DLBCL-RS treated in the modern era. More auto-HCT recipients were in complete response (CR) at HCT relative to allo-HCT recipients (66% vs 34%), whereas a higher proportion of allo-HCT recipients had 17p deletion (33% vs 7%) and had previously received novel agents (39% vs 10%). In the auto-HCT cohort, the 3-year relapse incidence, progression-free survival (PFS), and overall survival (OS) were 37%, 48%, and 57%, respectively. Among allo-HCT recipients, the 3-year relapse incidence, PFS, and OS were 30%, 43%, and 52%, respectively. In the allo-HCT cohort, deeper response at HCT was associated with outcomes (3-year PFS/OS, 66%/77% CR vs 43%/57% partial response vs 5%/15% resistant; P, .0001 for both), whereas cytogenetic abnormalities and prior novel therapy did not impact outcomes. In our study, HCT resulted in durable remissions in therapy-sensitive patients with DLBCL-RS treated in the era of targeted CLL/SLL therapy, including patients with high-risk features.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | Blood advances |
| Vol/bind | 5 |
| Udgave nummer | 18 |
| Sider (fra-til) | 3528-3539 |
| Antal sider | 12 |
| ISSN | 2473-9529 |
| DOI | |
| Status | Udgivet - 2021 |
Bibliografisk note
Funding Information:
The CIBMTR is supported primarily by Public Health Service U24CA076518 from the National Institutes of Health National Cancer Institute, the National Heart, Lung, and Blood Institute, and the National Institute of Allergy and Infectious Diseases. It is also supported by the Health Resources and Services Administration (HHSH250201700006C and HHSH250201700007C) and the Office of Naval Research (N00014-20-1-2705 and N00014-20-1-2832). Additional federal support is provided by the National Institutes of Health National Cancer Institute (R01CA215134), the National Institutes of Health National Institute of Allergy and Infectious Diseases (R01AI128775 U01AI126612), the National Institutes of Health National Heart, Lung, and Blood Institute (R01HL130388), the National Institutes of Health National Eye Institute (UG1HL06924), and the Biomedical Advanced Research and Development Authority. Support is also provided by Be the Match Foundation, Boston Children’s Hospital, Dana Farber, St. Baldrick’s Foundation, Stanford University, the Medical College of Wisconsin the National Marrow Donor Program, and the following commercial entities: Actinium Pharmaceuticals, Inc., Adienne SA, AlloVir, Inc., Amgen, Inc., Angiocrine Bioscience, Astellas Pharma US, bluebird bio, Inc., Bristol Myers Squibb Co., Celgene Corp., CSL Behring, CytoSen Therapeutics, Inc., Daiichi Sankyo Co., Ltd., ExCellThera, Fate Therapeutics, Gamida-Cell, Ltd., Gen-entech Inc., Incyte Corporation, Janssen/Johnson & Johnson, Jazz Pharmaceuticals, Inc., Kiadis Pharma, Kite, a Gilead Company, Kyowa Kirin, Legend Biotech, Magenta Therapeutics, Merck Sharp & Dohme Corp., Millennium, the Takeda Oncology Co., Miltenyi Biotec, Inc., Novartis Pharmaceuticals Corporation, Omeros Corporation, OncoImmune, Inc., Orca Biosystems, Inc., Pfizer, Inc., Pharmacyclics, LLC, Sanofi Genzyme, StemCyte, Takeda Pharma, Vor Biopharma, and Xenikos BV.
Funding Information:
The CIBMTR is supported primarily by Public Health Service U24CA076518 from the National Institutes of Health National Cancer Institute, the National Heart, Lung, and Blood Institute, and the National Institute of Allergy and Infectious Diseases. It is also supported by the Health Resources and Services Administration (HHSH250201700006C and HHSH250201700007C) and the Office of Naval Research (N00014-20-1-2705 and N00014-20-1-2832). Additional federal support is provided by the National Institutes of Health National Cancer Institute (R01CA215134), the National Institutes of Health National Institute of Allergy and Infectious Diseases (R01AI128775 U01AI126612), the National Institutes of Health National Heart, Lung, and Blood Institute (R01HL130388), the National Institutes of Health National Eye Institute (UG1HL06924), and the Biomedical Advanced Research and Development Authority. Support is also provided by Be the Match Foundation, Boston Children?s Hospital, Dana Farber, St. Baldrick?s Foundation, Stanford University, the Medical College of Wisconsin the National Marrow Donor Program, and the following commercial entities: Actinium Pharmaceuticals, Inc., Adienne SA, AlloVir, Inc., Amgen, Inc., Angiocrine Bioscience, Astellas Pharma US, bluebird bio, Inc., Bristol Myers Squibb Co., Celgene Corp., CSL Behring, CytoSen Therapeutics, Inc., Daiichi Sankyo Co., Ltd., ExCellThera, Fate Therapeutics, Gamida-Cell, Ltd., Genentech Inc., Incyte Corporation, Janssen/Johnson & Johnson, Jazz Pharmaceuticals, Inc., Kiadis Pharma, Kite, a Gilead Company, Kyowa Kirin, Legend Biotech, Magenta Therapeutics, Merck Sharp & Dohme Corp., Millennium, the Takeda Oncology Co., Miltenyi Biotec, Inc., Novartis Pharmaceuticals Corporation, Omeros Corporation, OncoImmune, Inc., Orca Biosystems, Inc., Pfizer, Inc., Pharmacyclics, LLC, Sanofi Genzyme, StemCyte, Takeda Pharma, Vor Biopharma, and Xenikos BV.
Publisher Copyright:
© 2021 by The American Society of Hematology.
ID: 303581362