Reduced intensity conditioning prior to autologous stem cell transplantation in elderly DLBCL patients

Abstract

Abstract High-dose chemotherapy (HDCT) followed by autologous stem cell transplantation (ASCT) is widely used in diffuse-large B-cell lymphoma (DLBCL) patients in a curative approach. Since HDCT/ASCT is associated with increased morbidity in elderly/unfit DLBCL patients, we retrospectively investigated the use of reduced-intensity conditioning prior to ASCT in this cohort. Between 2005 and 2019 146 patients aged ≥ 60 years were treated; 86 patients received standard intensity conditioning (SI-group) with BEAM/TEAM (BCNU/thiotepa, etoposide, cytarabine, melphalan). 60 patients received reduced intensity conditioning (RI-group) with BM (BCNU, melphalan, 43.3%), TM (thiotepa, melphalan 16.7%), BCNU- or busulfan-thiotepa (38.4%) or bendamustin-melphalan (1.7%). While patient characteristics differed significantly between the SI- and RI-groups, acute toxicities and non-relapse mortality were comparable. The cumulative incidence of relapse at 3 years was higher in the RI-group (30.8% vs. 23.4%, p = 0.034, median follow-up: 62.4 month). Nevertheless, in multivariate analyses, no difference in PFS (HR 0.74 CI 0.40–1.38, p = 0.345) and a trend for better OS with RI-conditioning (HR 0.45 CI 0.22–0.94, p = 0.032) could be detected. ASCT in frontline DLBCL treatment was also associated with superior OS. In summary, RI-conditioning prior to ASCT is feasible in elderly patients and led to a comparable outcome when corrected for multiple significant confounders.