Autologous and allogeneic hematopoietic cell transplantation for diffuse large B-cell lymphoma–type Richter syndrome

Alex F. Herrera, Kwang Woo Ahn, Carlos Litovich, Yue Chen, Amer Assal, Qaiser Bashir, Ruthee Lu Bayer, Melanie Coleman, Zachariah DeFilipp, Nosha Farhadfar, Matthew Greenwood, Theresa Hahn, Mitchell Horwitz, Caron Jacobson, Samantha Jaglowski, Sylvie Lachance, Amelia Langston, Bassam Mattar, Richard T. Maziarz, Joseph McGuirkMohammad A.H. Mian, Sunita Nathan, Adrienne Phillips, Kevin Rakszawski, Henrik Sengeloev, Shalini Shenoy, Robert Stuart, Craig S. Sauter, Mohamed A. Kharfan-Dabaja, Mehdi Hamadani

Research output: Contribution to journalArticlepeer-review

Abstract

Richter syndrome (RS) represents a transformation from chronic lymphocytic leukemia/ small lymphocytic lymphoma (CLL/SLL) to aggressive lymphoma, most commonly diffuse large B-cell lymphoma (DLBCL), which is associated with a dismal prognosis. Patients with DLBCL-RS have poor outcomes with DLBCL-directed therapy; thus, consolidation with hematopoietic cell transplantation (HCT) has been used, with durable remissions observed. Studies reporting HCT outcomes in patients with DLBCL-RS have been small, have not evaluated the prognostic impact of cytogenetic risk factors, and were conducted prior to the era of novel targeted therapy of CLL/SLL. We performed a Center for International Blood and Transplant Research registry study evaluating outcomes after autologous HCT (auto-HCT; n 5 53) and allogeneic HCT (allo-HCT; n 5 118) in patients with DLBCL-RS treated in the modern era. More auto-HCT recipients were in complete response (CR) at HCT relative to allo-HCT recipients (66% vs 34%), whereas a higher proportion of allo-HCT recipients had 17p deletion (33% vs 7%) and had previously received novel agents (39% vs 10%). In the auto-HCT cohort, the 3-year relapse incidence, progression-free survival (PFS), and overall survival (OS) were 37%, 48%, and 57%, respectively. Among allo-HCT recipients, the 3-year relapse incidence, PFS, and OS were 30%, 43%, and 52%, respectively. In the allo-HCT cohort, deeper response at HCT was associated with outcomes (3-year PFS/OS, 66%/77% CR vs 43%/57% partial response vs 5%/15% resistant; P, .0001 for both), whereas cytogenetic abnormalities and prior novel therapy did not impact outcomes. In our study, HCT resulted in durable remissions in therapy-sensitive patients with DLBCL-RS treated in the era of targeted CLL/SLL therapy, including patients with high-risk features.

Original languageEnglish (US)
Pages (from-to)3528-3539
Number of pages12
JournalBlood Advances
Volume5
Issue number18
DOIs
StatePublished - Sep 28 2021

ASJC Scopus subject areas

  • Hematology

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