OBJECTIVES: High-dose chemotherapy and autologous stem-cell transplant (HDT-ASCT) is standard second-line consolidation therapy in relapsed or refractory large B-cell lymphoma (R/R LBCL). However, a large proportion of patients are considered ineligible for this treatment. This study examines the impact of ASCT-eligibility on survival outcomes in R/R LBCL.

METHODS: This retrospective, observational study included patients with R/R LBCL treated at one of six English referral centers. Patients who met inclusion criteria were stratified by ASCT-eligibility. The ASCT-eligible group comprised both those who had received ASCT, and those who were eligible for but did not receive ASCT. Eligibility was assessed based on second-line regimen received, and predefined physiological parameters validated by clinical experts. The Kaplan-Meier method was used to estimate survival probability. Hazard ratios (HRs) were estimated using a univariate Cox proportional hazards model with ASCT-eligible as reference.

RESULTS: In total, 299 patients met eligibility criteria, of whom 223 were ASCT-eligible, 49 ineligible, and 27 unclassified. ASCT-eligible patients were younger than ineligible patients (mean age 56.5 vs. 74.7 years), with lower ECOG scores (60.1% vs. 42.9% with ECOG 0-1). Of the ASCT-eligible group, 98 patients (40.4%) underwent ASCT. Median overall survival was 18.71 months [95% CI: 13.15–33.44] and 6.94 months [95% CI: 4.77–9.11] for ASCT-eligible and ineligible patients respectively, with an HR of 2.39 [95% CI: 1.70–3.37] for death. Median progression-free survival was 6.67 months [95% CI: 4.67–8.71] and 4.27 months [95% CI: 2.40–6.35] respectively, with an HR of 1.54 [95% CI: 1.10–2.15] for progression. Median event-free survival was 6.08 months [95% CI: 3.95–7.99] and 4.27 months [95% CI: 2.40–6.35] respectively, with a HR of 1.46 [95% CI: 1.05–2.04] for an event.

CONCLUSIONS: Over half of ASCT-eligible patients did not receive ASCT. Nevertheless, ASCT-eligible patients have significantly better survival outcomes than ineligible patients, highlighting an unmet need in the ASCT-ineligible population.