Hematopoietic stem cell transplantation for DLBCL: a report from the European Society for Blood and Marrow Transplantation on more than 40,000 patients over 32 years

• Published in: Blood cancer journal (New York) Vol. 14; no. 1; pp. 106 - 13
• Main Authors: Berning, Philipp, Fekom, Mathilde, Ngoya, Maud, Goldstone, Anthony H., Dreger, Peter, Montoto, Silvia, Finel, Hervé, Shumilov, Evgenii, Chevallier, Patrice, Blaise, Didier, Strüssmann, Tim, Carpenter, Ben, Forcade, Edouard, Castilla-Llorente, Cristina, Trneny, Marek, Ghesquieres, Hervé, Capria, Saveria, Thieblemont, Catherine, Blau, Igor Wolfgang, Meijer, Ellen, Broers, Annoek E. C., Huynh, Anne, Caillot, Denis, Rösler, Wolf, Nguyen Quoc, Stephanie, Bittenbring, Jörg, Nagler, Arnon, Galimard, Jacques-Emmanuel, Glass, Bertram, Sureda, Anna, Schmitz, Norbert
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 05.07.2024; Springer Nature B.V; Nature Publishing Group
• Subjects: 692/699/67/1990/291/1621/1915; 692/700/1750/1976; Adolescent; Adult; Aged; Biomedical and Life Sciences; Biomedicine; Cancer Research; Europe - epidemiology; Female; Hematology; Hematopoietic Stem Cell Transplantation - methods; Humans; Lymphoma, Large B-Cell, Diffuse - mortality; Lymphoma, Large B-Cell, Diffuse - therapy; Male; Middle Aged; Oncology; Stem cell transplantation; Transplantation Conditioning - methods; Transplantation, Autologous; Transplantation, Homologous; Young Adult; Europe
• ISSN: 2044-5385; 2044-5385
• DOI: 10.1038/s41408-024-01085-9

Autologous(auto-) and allogeneic(allo-) hematopoietic stem cell transplantation (HSCT) are key treatments for relapsed/refractory diffuse large B-cell lymphoma (DLBCL), although their roles are challenged by CAR-T-cells and other immunotherapies. We examined the transplantation trends and outcomes for DLBCL patients undergoing auto-/allo-HSCT between 1990 and 2021 reported to EBMT. Over this period, 41,148 patients underwent auto-HSCT, peaking at 1911 cases in 2016, while allo-HSCT saw a maximum of 294 cases in 2018. The recent decline in transplants corresponds to increased CAR-T treatments (1117 cases in 2021). Median age for auto-HSCT rose from 42 (1990–1994) to 58 years (2015–2021), with peripheral blood becoming the primary stem cell source post-1994. Allo-HSCT median age increased from 36 (1990–1994) to 54 (2015–2021) years, with mobilized blood as the primary source post-1998 and reduced intensity conditioning post-2000. Unrelated and mismatched allo-HSCT accounted for 50% and 19% of allo-HSCT in 2015–2021. Three-year overall survival (OS) after auto-HSCT improved from 56% (1990–1994) to 70% (2015–2021), p  < 0.001, with a decrease in relapse incidence (RI) from 49% to 38%, while non-relapse mortality (NRM) remained unchanged (4%). After allo-HSCT, 3-year-OS increased from 33% (1990–1999) to 46% (2015–2021) ( p  < 0.001); 3-year RI remained at 39% and 1-year-NRM decreased to 19% ( p  < 0.001). Our data reflect advancements over 32 years and >40,000 transplants, providing insights for evaluating emerging DLBCL therapies.