Autologous and allogeneic hematopoietic cell transplantation for diffuse large B-cell lymphoma-type Richter syndrome

Alex F Herrera, Kwang Woo Ahn, Carlos Litovich, Yue Chen, Amer Assal, Qaiser Bashir, Ruthee-Lu Bayer, Melanie Coleman, Zachariah DeFilipp, Nosha Farhadfar, Matthew Greenwood, Theresa Hahn, Mitchell Horwitz, Caron Jacobson, Samantha Jaglowski, Sylvie Lachance, Amelia Langston, Bassam Mattar, Richard T Maziarz, Joseph McGuirkMohammad A H Mian, Sunita Nathan, Adrienne Phillips, Kevin Rakszawski, Henrik Sengeloev, Shalini Shenoy, Robert Stuart, Craig S Sauter, Mohamed A Kharfan-Dabaja, Mehdi Hamadani

Abstract

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 = 53) and allogeneic HCT (allo-HCT; n = 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.

OriginalsprogEngelsk
TidsskriftBlood advances
Vol/bind5
Udgave nummer18
Sider (fra-til)3528-3539
Antal sider12
ISSN2473-9529
DOI
StatusUdgivet - 28 sep. 2021

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