Purpose: To evaluate the efficacy of auto-HSCT in DLBCL and identify prognostic factors influencing outcomes.
Methods: A retrospective analysis was conducted on 49 DLBCL patients who underwent auto-HSCT at the Department of Hematology, First Affiliated Hospital of USTC, between 10/2018 and 8/2023.
Results:
Patient characteristics: Median age: 48 years (16–63); Male: 59.2% (29/49). Advanced-stage disease (Ann Arbor III–IV) was present in 71.4% (35/49). High-risk NCCN-IPI (≥4) was observed in 53% (26/49). Extranidal involvement at diagnosis occurred in 67.3% (33/49), including bone marrow infiltration (20.4%, 10/49) and gastrointestinal involvement (20.4%, 10/49). B symptoms were present in 40.8% (20/49). Pre-transplant disease status: CR1 65.3% (32/49), CR2 20.4% (10/49), PR 6.1% (3/49), refractory 8.2% (4/49).
Transplant Indications & Regimens: Upfront consolidation post-first-line therapy (33/49, 67.3%) required ≥1 high-risk feature: NCCN-IPI >3, stage III–IV, bulky disease, DHL, DEL, TP53 mutation, or CD5+. Salvage therapy for relapse comprised 32.7% (16/49). DEL (Bcl-2+/c-Myc+) was identified in 30.6% (15/49), CD5+ in 18.4% (9/49), and DHL in 2.0% (1/49). Conditioning regimens: BEAC (55.1%, 27/49), BeEAM (28.6%, 14/49), BEAM (8.2%, 4/49), CBV (8.2%, 4/49). Post-HSCT lenalidomide maintenance was administered to 36.7% (18/49).
Survival Outcomes: At a median follow-up of 26.6m post-HSCT, the 2-year OS and PFS rates for the entire cohort were 83.7% and 79.1%. Significant prognostic factors included:
Superior PFS with upfront consolidation vs. salvage (89.3% vs. 61.3%; P=0.02).
Higher OS (100% vs. 67.9%; P=0.008) and PFS (94.7% vs. 66.7%; P=0.016) for NCCN-IPI ≤3 vs. >3.
Improved PFS and OS with CD34+ cell dose ≥2×10⁶/kg vs. <2×10⁶/kg (P<0.05).
Superior PFS with BEAM/BeEAM conditioning vs. BEAC (P<0.05).
PFS benefit with lenalidomide maintenance vs. no maintenance (PFS: P=0.04).
Conclusion: Auto-HSCT is an effective consolidation strategy for high-risk DLBCL patients. Transplant timing (upfront consolidation) and baseline NCCN-IPI score are critical determinants. Lenalidomide maintenance therapy post-auto-HSCT confers a significant PFS advantage.