As CAR-T emerges, stem cell transplants for lymphoma in ‘marked decline’
Click Here to Manage Email Alerts
Key takeaways:
- Treatment outcomes have improved significantly with both auto- and allo-HSCT over the past 3 decades.
- Both transplant modalities are experiencing a decline in frequency as CAR-T infusions increase.
SAN DIEGO — The volume of hematopoietic stem cell transplantation procedures for advanced diffuse large B-cell lymphoma has declined precipitously since 2019, study results presented at ASH Annual Meeting and Exhibition showed.
The Europe-based retrospective analysis revealed a steep drop in both autologous and allogeneic HSTC that coincided with the introduction of commercially available chimeric antigen receptor T-cell therapies. The trend emerged despite a significant improvement in treatment outcomes using both forms of the transplant procedure, according to study investigators.
“There has been a marked decline in both transplant modalities since 2019,” Philipp Berning, MD, of University Hospital Muenster in Germany, said during a presentation. “This has been paralleled by the increased use of CAR T cells since then.”
Background and methodology
Allo- and auto-HSTC have been established treatments for eligible patients with relapsed or refractory diffuse large B-cell lymphoma since the early 1990s, according to Berning.
“Transplant modalities and indications have improved over time and, more recently, CAR T-cell therapies have challenged the role of auto- and allo-HSTC for the treatment of DLBCL,” he said. “Comprehensive reports from the EBMT date back 15 or more years, so we set out to conduct a retrospective analysis of outcome data and clinical data of patients registered with the European Society of Bone Marrow Transplantation.”
Berning and colleagues conducted a retrospective study of adults who received allo- and auto-HSCT for the treatment of DLBCL using information from the EBMT database. The analysis also included data on individuals who received CAR T-cells during the latter end of the study period.
Their investigation aimed to compare temporal trends in treatment modalities and patient outcomes for the period between 1990 and 2022.
Key findings
Study results showed that, between 1990 and 2020, 50,776 patients received an auto-HSCT, with an additional 5,282 receiving allo-HSCT. A total of 3,444 patients underwent CAR T-cell infusion between 2014 and 2022.
The number of auto-HSCT procedures performed increased significantly over time, from 937 for the period between 1990 to 1994 to a peak of 10,053 between 2015 and 2019. Treatment outcomes associated with auto-HSCT also improved over the study period. The proportion of patients who had a complete or partial response to therapy increased from 72.6% between 1990 and 1995 to 92.2% between 2015 and 2019.
At a median follow-up of 3.7 years (range, 0-30.8), 3-year OS among auto-HSCT recipients increased significantly over time, starting at 57% between 1990 and 1994 and rising to 71% between 2015 and 2019 (P < .001). The disease relapse rate declined from 50% to 36% over the same period (P < .001).
The volume of allo-HSCT increased significantly from 41 procedures between 1990 and 1994 to 1,381 from 2015 to 2018.
At a median follow-up of 4.7 years (range, 0-28.6), researchers observed significant improvement in 3-year OS rates for those who received allo-HSCT, which increased from 35% between 1990 and 1999 to 46% from 2015 to 2019 (P < .001).
Significant improvement in 3-year PFS rates (P < .001) and response rates (P < .0001) occurred during the same period.
Notably, since 2019, the number of transplantation procedures has declined each year, with 1,548 auto-HSCT and 124 allo-HSCT conducted in 2022. Meanwhile, the frequency of CAR-T cell infusions has increased each year during the same period, increasing from 537 in 2019 to 809 in 2022.
Clinical implications
“This large real-world data set may reflect clinical practice over a period of 30 years, highlighting clinical outcomes and comprehensively showing treatment modalities for over 40,000 patients,” Berning said. “It may provide a benchmark for evaluating CAR T cells and other emerging treatment modalities.”
Collapse
Berning P, et al. Abstract 441. Presented at: ASH Annual Meeting and Exhibition; Dec. 9-12, 2023; San Diego.
Click Here to Manage Email Alerts