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786 Autologous Stem Cell Transplantation Remains a Curative Option As Second Line Treatment for Patients with Relapsed/Refractory Large B Cell Lymphoma: Spanish Multicenter Geth-TC/Geltamo Study

Program: Oral and Poster Abstracts
Type: Oral
Session: 731. Autologous Transplantation: Clinical and Epidemiological: Role of Autologous Stem Cell Transplantation in Multiple Myeloma and Lymphomas: A Therapeutic Approach
Hematology Disease Topics & Pathways:
Lymphomas, B Cell lymphoma, Diseases, aggressive lymphoma, Therapies, Lymphoid Malignancies
Monday, December 11, 2023: 11:45 AM

Leyre Bento1*, Antonio Gutiérrez, MD, PhD1*, Carmen Martínez2*, Consejo Ortí3*, Marina Sorribes4*, Ana Carolina Caballero4*, Marta Peña5*, Ariadna Pérez6*, Ana Jimenez Ubieto7*, Mariana Bastos-Oreiro8*, Paula Fernández Caldas-González8*, Belén Navarro9*, Isabel Salcedo10*, Pau Abrisqueta Costa11*, Ignacio Español12*, Javier Cornago13*, Fernando Martín-Moro14*, Lucía García15*, Pilar Gómez16*, Rosario Varela17*, María Puente18*, Joud Zanabili19*, Teresa Zudaire20*, Izaskun Zeberio21*, Raquel Del Campo22*, Leslie González23*, Pedro Gonzalez-Sierra24*, Cristina Blázquez Goñi25*, Jordina Rovira26*, Marta Sitges27*, Mireia Franch28*, Almudena Cabero29*, Alberto Mussetti5*, Juan Montoro3*, Antonia Sampol Mayol1*, Anna Maria Sureda Balari, MD, PhD5, Dolores Caballero29* and Alejandro Martín García-Sancho29*

1Hematology Department, Hospital Universitario Son Espases, IdISBa, Palma de Mallorca, Spain
2Hematology Department, Hospital Clinic, Barcelona, Spain
3Hematology Department, Hospital La Fe, Valencia, Spain
4Hematology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
5Clinical Hematology Department, Institut Català d’Oncologia-Hospitalet, IDIBELL, Barcelona, Spain
6Hematology Department, Hospital Clínico de Valencia, Valencia, Spain
7Hospital Universitario 12 de Octubre, MADRID, MADRID, Spain
8Hematology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
9Hospital Universitario Puerta de Hierro, Majadahonda, Spain
10Hematology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
11Vall d'Hebron University Hospital, Barcelona, Spain
12Hematology Department, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
13Hematology Department, Fundación Jiménez Díaz, Madrid, ESP
14Hematology Department, Hospital Ramón y Cajal, Madrid, Spain
15Hospital Morales Meseguer, Murcia, Spain
16Hematology Department, Hospital La Paz, Madrid, Spain
17Hematology Department, Complejo Hospitalario Universitario A Coruña, A Coruna, ESP
18Hematology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
19Hematology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
20Hematology Department, Complejo Hospitalario de Navarra, Pamplona, ESP
21Hematology Department, Hospital Universitario Donostia, San Sebastian, ESP
22Hematology Department, Hospital Universitario Son Llàtzer, Palma de Mallorca, ESP
23Hematology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
24Hematology Department, Complejo Universitario de Granada, Granada, ESP
25Hematology Department, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS / CSIC / CIBERONC), Sevilla, Spain
26Hematology Department, Hospital Universitari de Tarragona Joan XXIII, Institut Català d`Oncologia, Tarragona, ESP
27Hematology Department, Institut Català d`Oncologia, Girona, ESP
28ICO-IJC-Hospital Germans Trias i Pujol, Barcelona, Spain
29Hematology Department, Hospital Universitario de Salamanca, IBSAL, CIBERONC, University of Salamanca, Salamanca, Spain


High dose therapy and Autologous Stem Cell Transplantation (ASCT) has remained the treatment of choice for transplant-eligible patients with relapsed/refractory (R/R) large B cell lymphoma (LBCL) and chemosensitive disease. Recently, CART therapy has been approved in second line for patients with primary refractory disease or early relapse (<1 year of first-line therapy) and the current role of ASCT has been questioned. However, several studies have shown that despite early failure of first line, patients with chemosensitive disease after salvage therapy can be cured with ASCT consolidation. Our objective was to analyze the efficacy of ASCT in patients with R/R LBCL after a long-term follow up and try to define the optimal role of ASCT.

Patients and methods:

We performed a retrospective multicenter study based on GETH-TC database of ASCT. We included patients from centers of GETH-TC/GELTAMO with R/R LBCL who underwent ASCT from January 2010 to December 2021. All the patients received rituximab and anthracycline-based frontline therapy. Diffuse LBCL NOS, high-grade B-cell lymphoma double/triple hit and NOS, primary mediastinal, transformed follicular lymphoma (tFL) and other less frequent LBCL subtypes were included. Plasmablastic and primary central nervous system lymphoma were excluded. Patients who underwent ASCT in first CR were also excluded except patients with tFL who had received previous anthracycline-based frontline therapy for the indolent lymphoma. The primary endpoints were progression-free survival (PFS) and overall survival (OS) in the overall series and according to different prognostic factors, including disease status at ASCT. Disease status was defined as complete remission (CR), partial response (PR) and refractory disease (stable disease or progression) assessed by PET/CT.


Seven-hundred and ninety-one patients fulfilled the inclusion criteria. Patients characteristics are summarized in Table 1. After a median follow-up of 74 months (95%CI 68-81), 65% of the patients were alive and 84% of them free of disease. Six-year-PFS and OS were 51% (95%CI 47-54) and 63% (95%CI 60-67), respectively. Non-relapse mortality at 1 year was 9% (95%CI 7-11). The main causes of death were progression in 161 (58%), ASCT-related toxicity in 18 (6%) and other causes in 98 (35%). PFS was significantly influenced by age at ASCT, treatment lines prior to ASCT and disease status at ASCT (p<0.01). OS was influenced by age at diagnosis, R-IPI at diagnosis, age at ASCT, treatment lines prior to ASCT and disease status at ASCT (p<0.01). In the multivariate analysis, age >60 years at ASCT [HR 1.31 (95%IC: 1.06-1.62), p=0.011], ASCT as ≥3th line [HR 1.81 (95%IC: 1.42-2.31), p<0.001] and PR versus CR at ASCT [HR 1.46 (95%IC: 1.18-1.81), p<0.001] were the only independent variables influencing PFS, Figure 1. Age >60 years at ASCT [HR 1.62 (95%IC: 1.24-2.12), p<0.001], ASCT as ≥3th line [HR 1.77 (95%IC: 1.32-2.37), p<0.001] and PR versus CR at ASCT [HR 1.58 (95%IC: 1.22-2.05), p<0.001] were the only independent variables for OS. From 307 (39%) patients who relapsed after ASCT, 59 received CART therapy (median PFS 8.9 months) and 69 allo-SCT (median PFS 10.8 months).

Refractory disease or early relapse did not significantly influenced survival. Analyzing this population separately (n=477), disease status at ASCT (PR versus CR) and ASCT as ≥3th line were the only independent variables for both PFS [HR 1.46 (95%IC: 1.11-1.92), p=0.007; HR 1.79 (95%IC: 1.32-2.43), p<0.001, respectively] and OS [HR 1.92 (95%IC: 1.38-2.67), p<0.001; HR 1.91 (95%IC: 1.35-2.69), p<0.001, respectively].


To our knowledge, this is the largest series analyzing the efficacy of ASCT in patients with R/R LBCL after rituximab-containing frontline therapy. Our results indicate that ASCT is a curative option for patients with chemosensitive disease (especially in CR after salvage), regardless of the timing of relapse after frontline treatment. These data support that ASCT could be considered in patients with primary refractory or early relapse, provided the disease is sensitive to salvage therapy.

Disclosures: Martínez: Novartis: Honoraria, Research Funding. Caballero: BMS: Honoraria; Gilead: Honoraria; Novartis: Honoraria. Bastos-Oreiro: Kite-Gilead: Honoraria, Other: travel. Mussetti: BMS, Jazz Pharaceuticals: Consultancy; Gilead: Research Funding; Takeda: Honoraria. Sureda Balari: Astra Zeneca: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; BMS/Celgene: Consultancy, Honoraria, Research Funding; Pierre Fabre: Consultancy, Honoraria; Kite: Consultancy, Honoraria; Jannsen: Consultancy, Honoraria; Sanofi: Consultancy, Honoraria; GenMab: Consultancy, Honoraria; Takeda: Consultancy, Honoraria, Research Funding, Speakers Bureau; MSD: Consultancy, Honoraria. Martín García-Sancho: Sobi: Consultancy, Honoraria; Eusa Pharma: Honoraria; Takeda: Honoraria; Incyte: Consultancy; Lilly: Consultancy; ADC Therapeutics America: Consultancy; Miltenyi: Consultancy; Janssen: Honoraria; Gilead / Kite: Consultancy, Honoraria; Novartis: Consultancy; Kyowa Kirin: Consultancy; BMS/Celgene: Consultancy, Honoraria; Roche: Consultancy, Honoraria; Abbvie: Consultancy; Ideogen: Consultancy.

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