Allogeneic Hematopoietic Stem Cell Transplant for Diffuse Large B-Cell Lymphoma: Evolving Role in the Era of CAR T-Cell Therapy

Abstract

Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive lymphoma in adults. Although curable in the majority of cases, a substantial portion of patients will experience disease relapse and will die from their lymphoma. This review is aimed at summarizing the role of allogeneic hematopoietic stem cell transplant (allo-HSCT) in patients with relapsed DLBCL with a focus on its role in the era of CAR T-cell therapy RECENT FINDINGS: Allo-HSCT is primarily reserved for patients who experience disease progression or relapse after CAR T-cell therapy, largely due to the high non-relapse mortality (NRM) associated with the procedure. Disease status at the time of allo-HSCT is prognostic with complete remission (CR) associated with better outcomes. Reduced-intensity conditioning (RIC) is likely as effective as myeloablative conditioning (MAC) with less toxicity. In patients with multiply relapsed disease, including after auto-HSCT and CAR T-cell therapy, approximately one-third can be cured with allo-HSCT. Allo-HSCT should be considered a treatment modality for fit adults without major comorbid conditions whose disease can be controlled with emerging treatment modalities (e.g., bispecifics, antibody-drug conjugates).

Keywords: Allogeneic BMT; CAR T-cell therapy; DLBCL.