Scientific Publications Database

Article Title: ASTCT Clinical Practice Recommendations for Transplantation and Cellular Therapies in Diffuse Large B Cell Lymphoma
Authors: Epperla, Narendranath; Kumar, Ambuj; Abutalib, Syed A.; Awan, Farrukh T.; Chen, Yi-Bin; Gopal, Ajay K.; Holter-Chakrabarty, Jennifer; Kekre, Natasha; Lee, Catherine J.; Lekakis, Lazaros; Lin, Yi; Mei, Matthew; Nathan, Sunita; Nastoupil, Loretta; Oluwole, Olalekan; Phillips, Adrienne A.; Reid, Erin; Rezvani, Andrew R.; Trotman, Judith; Zurko, Joanna; Kharfan-Dabaja, Mohamed A.; Sauter, Craig S.; Perales, Miguel-Angel; Locke, Frederick L.; Carpenter, Paul A.; Hamadani, Mehdi
Journal: TRANSPLANTATION AND CELLULAR THERAPY Volume 29 Issue 9
Date of Publication:2023
Abstract:
Autologous hematopoietic cell transplantation (auto-HCT) has long been the standard approach for patients with relapsed/refractory (R/R) chemosensitive diffuse large B cell lymphoma (DLBCL). However, the advent of chimeric antigen receptor (CAR) T cell therapy has caused a paradigm shift in the management of R/R DLBCL patients, especially with the recent approval of CD19-directed CAR-T therapy in the second-line setting in high-risk groups (primary refractory and early relapse [<= 12 months]). Consensus on the contemporary role, optimal timing, and sequencing of HCT and cellular therapies in DLBCL is lacking; therefore, the American Society of Transplantation and Cellular Therapy (ASTCT) Committee on Practice Guidelines undertook this project to formulate consensus recommendations to address this unmet need. The RAND-modified Delphi method was used to generate 20 consensus statements with a few key statements as follows: (1) in the first-line setting, there is no role for auto-HCT consolidation for patients achieving complete remission (CR) following R-CHOP (rituximab, cyclophosphamide, adriamycin, vincristine, and prednisone) or similar therapy in non-double-hit/triple-hit cases (DHL/THL) and in DHL/THL cases receiving intensive induction therapies, but auto-HCT may be considered in eligible patients receiving R-CHOP or similar therapies in DHL/THL cases; (2) auto-HCT consolidation with thiotepa-based conditioning is standard of care for eligible patients with primary central nervous system lymphoma achieving CR with first-line therapy; and (3) in the primary refractory and early relapse setting, the preferred option is CAR-T therapy, whereas in late relapse (>12 months), consolidation with auto-HCT is recommended for patients achieving chemosensitivity to salvage therapy (complete or partial response), and CAR-T therapy is recommended for those not achieving remission. These clinical practice recommendations will serve as a tool to guide clinicians managing patients with newly diagnosed and R/R DLBCL. (c) 2023 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).