The Effect of the Pre-Transplant Disease Status on the Outcome for Recipients of T-Cell Depleted Allogeneic Haematopoietic Stem Cell Transplants for Large B Cell Lymphomas.

Abstract

Objectives: Deauville scores (DS) from PET/CT imaging are increasingly being used to direct response-adjusted treatment strategies in lymphoma, including large B cell lymphomas (LBCL). We aimed to investigate the outcome of allogeneic haematopoietic stem cell transplantation (alloHSCT) in LBCL and the role played by pre-transplant disease status, as determined by DS.

Methods: We performed a retrospective, observational study of adults treated with a T-cell depleted alloHSCT for de novo DLBCL or high-grade transformation.

Results: Sixty-four patients received an alloHSCT. Forty-four had acute GvHD (38 had Grade 1-2). Overall non-relapse mortality (NRM) at 1 year was 20.31%. Patients ≥ 55 years had a higher cumulative incidence of NRM (66.67%) than those who were < 55 years (25.08%) (p = 0.00660). A 4-year relapse risk was 22.5%. Fourteen patients had disease relapse. The 4-year overall survival (OS) was 49.80%; median OS was 3.7 years (1.4-7.1). Patients with a pre-alloHSCT DS of 1-2 had a higher OS than a DS of 3-5 (61.97% vs. 34.23%; p = 0.0167); this was confirmed on multivariate analysis. Younger patients (< 55 years) had a higher OS than those ≥ 55 years (60.91% vs. 18.75%; p = 0.0246).

Conclusions: The pre-transplant Deauville score was predictive of the clinical outcome and patients with an absence of metabolically active disease pre-transplant had superior outcomes.