Upfront autologous hematopoietic stem cell transplantation in patients with high-risk diffuse large B-cell lymphoma: A real-world multicenter study
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND AND PURPOSE: The ability of autologous hematopoietic stem cell transplantation (ASCT) to improve the benefit of patients with high-risk diffuse large B-cell lymphoma (DLBCL) who achieved complete remission (CR) following induction chemotherapy is controversial. This multicenter real-world study aimed to explore the efficacy and safety of the rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) regimen followed by consolidated ASCT therapy in newly diagnosed DLBCL. METHODS: From June 2018 to June 2021, the clinical data of patients with high-risk DLBCL who reached CR after receiving the R-CHOP regimen from ten lymphoma diagnosis and treatment centers were analyzed. Patients were included in the R-CHOP+ASCT (with consolidated ASCT therapy, n = 60) and R-CHOP (follow-up without consolidated ASCT therapy, n = 60) groups. The efficacy in the two groups was compared by difference analysis, and the safety of R-CHOP+ASCT was analyzed. RESULTS: Until June 2024, the median follow-up times for the R-CHOP+ASCT and R-CHOP groups were 44 (37.25-56) and 43.5 (38-52) months, respectively. Survivors were followed up for at least 36 months. In the R-CHOP+ASCT group, the 3-year disease-free survival (DFS) and overall survival (OS) rates were 89.7% and 96.7% and those in the R-CHOP group were 63.9% and 85.9%, respectively. The 3-year DFS rate in the R-CHOP+ASCT group was significantly higher than that in the R-CHOP group (89.7% vs 63.9%, P = 0.001); no significant difference was found in the 3-year OS rate between the R-CHOP+ASCT and R-CHOP groups (96.7% vs 85.9%, P = 0.113). The 5-year DFS and OS rates in the R-CHOP+ASCT group were 73.6% and 77.6% and those in the R-CHOP group were 56.5% and 81.1%, respectively. The 5-year DFS rate in the R-CHOP+ASCT group was significantly higher than that in the R-CHOP group (73.6% vs 56.5%, P = 0.009), whereas no significant difference was found in the 5-year OS rate between the R-CHOP+ASCT and R-CHOP groups (77.6% vs 81.1%, P = 0.246). In the Cox multifactorial analysis, discontinuous consolidated ASCT therapy, bone marrow invasion, and dual expression were poor prognostic factors that affect DFS [hazard ratio (HR), 5.710; 95% confidence interval (CI), 2.241-14.548, P < 0.001; HR, 4.324; 95% CI, 1.890-9.893, P = 0.001; HR, 2.565; 95% CI, 1.145-5.747, P = 0.022, respectively] and dual expression was a poor prognostic factor for OS (HR, 3.486; 95% CI, 1.300-9.344, P = 0.013). Grade IV myelosuppression after transplantation developed in the R-CHOP+ASCT group, and other common grade 3 or 4 treatment-related adverse events were infection and fever. CONCLUSION: For patients with newly diagnosed high-risk DLBCL, consolidated ASCT therapy can increase the DFS rate of those with CR status following the R-CHOP regimen, and the safety is controllable.
Institutions: Shenzhen University Health Science Center, Wuhan University of Science and Technology, Chinese Academy of Medical Sciences & Peking Union Medical College, University of Hong Kong - Shenzhen Hospital, Southern Medical University Shenzhen Hospital, Southern Medical University, Southern University of Science and Technology, Shenzhen Third People’s Hospital, Shantou Central Hospital, Guangzhou Medical University, Huizhou Central People's Hospital, Sun Yat-sen University, The Seventh Affiliated Hospital of Sun Yat-sen University, Beijing Tongren Hospital, Capital Medical University
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4410049780