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3363 Allogeneic Stem Cell Transplantation for Diffuse Large B Cell Lymphoma Can Achieve Durable Remissions: An Australasian Bone Marrow Transplant Recipient Registry Study

Program: Oral and Poster Abstracts
Session: 732. Clinical Allogeneic Transplantation: Results: Poster III
Hematology Disease Topics & Pathways:
Biological, Diseases, Therapies, Non-Hodgkin Lymphoma, DLBCL, Lymphoid Malignancies, Clinically relevant, transplantation
Monday, December 7, 2020, 7:00 AM-3:30 PM

Pietro R Di Ciaccio, BA/LLB MBBS FRACP FRCPA1,2, Matthew Greenwood, MBBS, FRACP, FRCPA3,4*, Glen A Kennedy, MBBS FRACP FRCPA5,6*, Sam Milliken, MBBS, FRACP, FRCPA2*, David Gottlieb, MBBS, MD, FRACP, FRCPA7,8*, David Ritchie, MB ChB, PhD, FRACP, FRCPA9,10, Duncan Purtill, MBBS, FRCPA, FRACP11,12,13*, Stephen R Larsen, MBBS PhD FRACP FRCPA14, Andrew Spencer15,16, Travis Perera, MB ChB, FRACP, FRCPA17*, David T Yeung, BSc, PhD, FRACP, FRCPA, MBBS18,19, Simon Durrant, MBBS FRCP FRCPath20,21, Andrew Butler, MB ChB(Edin), MRCP, MRCPath22*, Anne-Marie Watson, FRACP, FRCPA, MBBS23, Hock Choong Lai, MBBS, FRACP, FRCPA24, Richard Doocey, MB ChB, FRACP, FRCPA25, Hugh J. Goodman, FRACP26, Ian H. Kerridge, FRACP FRCPA MPhil BA27,28*, Christopher Arthur3,28, Cameron Curley, MBBS, FRACP, FRCPA5*, Caroline Stewart5*, Kenneth P. Micklethwaite, MBBS, PhD, FRACP, FRCPA4,7*, Jennifer Collins29*, Julian Cooney, FRACP, FRCPA, MBBS,30 and Nada Hamad, MBBS, BSc, MSc, FRACP FRCPA31,32

1University of New South Wales, Sydney, Australia
2Department of Haematology and Bone Marrow Transplantation, St Vincent's Hospital, Sydney, Australia
3Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia
4University of Sydney, Sydney, NSW, Australia
5Department of Haematology, Royal Brisbane and Women's Hospital, Brisbane, Australia
6School of Medicine, University of Queensland, St Lucia, QLD, Australia
7Department of Haematology and Bone Marrow Transplantation, Westmead Hospital, Sydney, NSW, Australia
8Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
9The University of Melbourne, Parkville, VIC, Australia
10Haematology Department, Royal Melbourne Hospital, Melbourne, VIC, Australia
11University of Western Australia, Perth, Australia
12PathWest Laboratory Medicine WA, Perth, Australia
13Department of Haematology, Fiona Stanley Hospital, Perth, Australia
14Institute of Haematology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
15Malignant Haematology & Stem Cell Transplantation Service, The Alfred Hospital, Melbourne, VIC, Australia
16Australian Centre for Blood Diseases, Monash University, Melbourne, VIC, Australia
17Wellington Blood and Cancer Centre, Wellington, New Zealand
18Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
19Department of Haematology, Royal Adelaide Hospital and SA Pathology, Adelaide, SA, Australia
20Wesley Clinic Research Centre Stem Cell Transplant Programme, Wesley Hospital, Brisbane, QLD, Australia
21University of Queensland, Brisbane, QLD, Australia
22Department of Haematology, Canterbury District Health Board, Christchurch, New Zealand
23Department of Haematology, Liverpool Hospital, Sydney, NSW, Australia
24Department of Haematology, Townsville Hospital, Townsville, Australia
25Department of Haematology, Auckland City Hospital, Auckland, New Zealand
26Department of Haematology, Waikato Hospital, Hamilton, New Zealand
27Department of Haematology, Royal North Shore Hospital, Sydney, Australia
28University of Sydney, Sydney, Australia
29Department of Haematology, Royal Melbourne Hospital, Melbourne, NSW, Australia
30Department of Haematology, Fiona Stanley Hospital, Perth, WA, Australia
31Department of Haematology, St Vincent's Hospital, Sydney, Australia
32Faculty of Medicine, University of New South Wales, Sydney, Australia


A majority of patients with diffuse large B cell lymphoma (DLBCL) will be cured with frontline chemoimmunotherapy, however a significant number of patients will relapse. Although autologous haematopoietic stem cell transplantation (autoHCT) may lead to sustained survival in some relapsing patients, long term survival with relapsed DLBCL is approximately 25% (Larouche et al., J Clin Oncol 2010;28(12):2094).

Allogeneic HCT (alloHCT) is a potential treatment strategy in some DLBCL patients with relapsed disease. We performed a retrospective national registry study to examine alloHCT practice and outcomes for DLBCL in Australia and New Zealand in the modern era.


Data was collected through the Australasian Bone Marrow Transplant Recipient Registry (ABMTRR) for patients receiving an alloHCT for DLBCL between January 2009 and December 2019. Survival was analysed using the Kaplan-Meier method, with comparisons between the transplant periods 2009-2014 and 2015-2019 performed using the log-rank test. Both univariate and Cox proportional hazards regression were performed to determine significant risk factors for transplant outcome. The following risk factors were analysed for impact on outcomes: age, transplant before 2015, previous autoHCT, remission status at transplant, use of myeloablative conditioning (MAC), haploidentical donor (HD) and use of T cell depletion (TCD).


A total of 154 patients were included in the analysis. The median age was 52 years (range 19-71) and 68% were male. Disease status at transplant was complete remission (CR) in 49%, partial response in 31% and stable or progressive disease in 17% (missing data in 3%). Fifty-five per cent had undergone a previous autoHCT. Approximately equal proportions of donors were HLA-matched siblings or matched unrelated (45% and 46% respectively) and 9% were HDs. MAC was utilised in 26%, and TCD in 24% (alemtuzumab in 3%, anti-thymocyte globulin in 21%) (data missing in 12%). The median times to neutrophil engraftment and platelet engraftment were 16 and 18 days respectively.

Non-relapse mortality (NRM) at 1-year and 5-years was 20% (95%CI 7-30%) and 26% (95%CI: 13-38%). The 100-day cumulative incidence of grade II to IV acute graft versus host disease was 15% (95%CI 5-31%). The 3-year cumulative incidence of chronic graft versus host disease (cGVHD) was 56% (95%CI 46-65%) (figure 1).

The median duration of follow up for the cohort was 3.98 years (range 0-9.64 years). Median overall survival (OS) post-transplant was 4.01 years, with 5-year OS of 47% (95%CI 38-56%) and 10-year OS of 40% (95%CI 26-54%) (figure 2). The 5-year relapse free survival (RFS) was 45% (95%CI 26-50%) (figure 3). The cumulative incidence of relapse (CIR) was 21% at 1 year and 32% at four years, however relapses were not seen after this point, suggesting a subpopulation with durable remissions (figure 4).

On univariate analysis, TCD was associated with both reduced incidence of cGVHD (HR 0.35 95%CI 0.19-0.66, p=0.012) and increased NRM (HR 2.10 95%CI 0.88-4.99 p=0.043). These associations were maintained on multivariate analysis (MVA) (HR 0.29 95%CI 0.16-0.76, p=0.011; HR 2.19 95%CI 1.02-4.70, p=0.045) (figures 5, 6). TCD did not impact on RFS. The vast majority of TCD was given in unrelated donor alloHCTs. CR at time of transplant was associated with improved RFS on univariate analysis (HR 1.65 95%CI 1.04-2.64, p=0.034), however this association was not seen on MVA. No other analysed risk factors impacted OS, RFS, NRM, CIR or GVHD rates on either univariate or MVA.

An average of 14 alloHCTs were performed each year, with a trend towards increasing annual numbers over time. There was a significant increase in the proportion of haploidentical transplants between 2009 and 2019 (p=0.003), though total numbers were low (n=14). There was no significant change over time for the use of MAC, TCD, nor in OS, RFS or NRM.


There has been an increase in the rates of alloHCT with HDs for DLBCL in Australia and New Zealand over the past decade. Survival and relapse rates are relatively favourable compared to the published literature, with sustained remissions observed (5 and 10-year OS of 47% and 40% respectively). TCD is associated with reduced cGVHD rates, as well as increased NRM. Ongoing reporting of alloHCT outcomes in DLBCL is important given the emerging role of novel therapies such as bispecific monoclonal antibodies and chimeric antigen receptor T cell therapy.

Disclosures: Di Ciaccio: Jansen: Honoraria, Other: travel and accomodation grant. Greenwood: Servier: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; MSD: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Spencer: Celgene, Janssen and Takeda: Speakers Bureau; AbbVie, Amgen, Celgene, Haemalogix, Janssen, Sanofi, SecuraBio, Specialised Therapeutics Australia, Servier and Takeda: Honoraria; Amgen, Celgene, Haemalogix, Janssen, Servier and Takeda: Research Funding; AbbVie, Celgene, Haemalogix, Janssen, Sanofi, SecuraBio, Specialised Therapeutics Australia, Servier and Takeda: Consultancy. Arthur: Royal North Shore Hospital: Current Employment. Hamad: Novartis: Honoraria; Abbvie: Honoraria.

*signifies non-member of ASH