Post-Transplant-Cyclophosphamide and short-term Everolimus as Graft-versus-Host-Prophylaxis in a real –world cohort of patients with refractory T- and B-cell Lymphoma

Abstract

Background: A growing array of therapies exists for aggressive lymphomas. However, for refractory lymphomas following CAR-T cell treatment, prospects are grim, often leaving allogeneic bone marrow transplantation (aHSCT) as the sole curative option for fit patients. In the prospective OCTET-EVER trial, low rates of NRM and encouraging overall survival (OS) outcomes were observed. Our objective was to validate these findings within the real-world context of refractory aggressive lymphoma. Methods: Our research delineates the characteristics and outcomes of 33 patients who underwent aHSCT for refractory aggressive b- and t-cell lymphoma at our center from 2019 to 2024. In line with the OCTET-EVER Trial, we employed a CNI-free strategy, utilizing post-transplant cyclophosphamide (PTCy) and short-term everolimus following reduced-intensity conditioning. Results: Median number of therapies prior to transplant of was 4, including autologous transplantation in all patients. With a median follow-up of 30,8 months median OS and PFS wasn’t reached. OS and PFS were 64% and 55% at 2 years follow-up, respectively. The cumulative incidence of relapse was 16% at 1 and 20% at 2 years after transplant, respectively. The cumulative incidence of NRM was 24,2% at 1 and 2 years. The GvHD-relapse-free-survival (GRFS) is 54% and 48% at 1 and 2 years, respectively. Conclusion: Treating real-life relapsed and refractory aggressive Lymphoma with post-transplant cyclophosphamide and short-term everolimus confirm the data from the prospective OCTET-EVER trial.