Autologous stem cell transplantation from 2000 to 2022 in Japanese patients aged ≥65 years with relapsed or refractory diffuse large B-cell lymphoma

Abstract High-dose chemotherapy with autologous stem cell transplantation (ASCT) is an option for patients aged ≥ 65 years with relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL). Few data are available to select patients suitable for chimeric antigen receptor T-cell (CAR-T) therapy or bispecific antibodies. We retrospectively analyzed the risk factors for poor outcomes for 575 Japanese patients aged ≥ 65 years with R/R DLBCL who received ASCT at either second complete remission or first partial remission between 2000 and 2010 (n = 82 and 42) or 2011 and 2022 (n = 336 and 115), respectively. CAR-T became commercially available in Japan in March 2019, and the annual number of ASCTs for older patients with R/R DLBCL increased significantly until 2018. However, the number of ASCT cases plateaued in 2018. Multivariate Cox regression analysis identified performance status of 0 at ASCT and receiving ASCT after 2011 as independent predictors of overall survival and an association with late recurrence and better progression-free survival. CAR-T therapy or bispecific antibodies may be used initially instead of ASCT for early relapsed and refractory patients. ASCT remains beneficial for older chemo-sensitive patients with late recurrence and good performance status at ASCT.