ASTCT Clinical Practice Recommendations for Transplantation and Cellular Therapies in Diffuse Large B Cell Lymphoma

• DOI: 10.1016/j.jtct.2023.06.012
• Publication Date: 2023-07-05T06:19:04Z
• Authors: Narendranath Epperla; Ambuj Kumar; Syed A. Abutalib; Farrukh T. Awan; Yi-Bin Chen; Ajay K. Gopal; Jennifer Holter-C...; Natasha Kekre; Catherine J. Lee; Lazaros Lekakis; Yi Lin; Matthew Mei; Sunita Nathan; Loretta Nastoupil; Olalekan Oluwole; Adrienne A. Phillips; Erin Reid; Andrew R. Rezvani; Judith Trotman; Joanna Zurko; Mohamed A. Kharfa...; Craig S. Sauter; Miguel-Angel Perales; Frederick L. Locke; Paul A. Carpenter; Mehdi Hamadani
• Keywords: ThioTEPA; Salvage therapy

Autologous hematopoietic cell transplantation (auto-HCT) has long been the standard approach for patients with relapsed/refractory (R/R) chemosensitive diffuse large B lymphoma (DLBCL). However, advent of chimeric antigen receptor (CAR) T therapy caused a paradigm shift in management R/R DLBCL patients, especially recent approval CD19-directed CAR-T second-line setting high-risk groups (primary refractory and early relapse [≤12 months]). Consensus on contemporary role, optimal timing, sequencing HCT cellular therapies is lacking; therefore, American Society Transplantation Cellular Therapy (ASTCT) Committee Practice Guidelines undertook this project to formulate consensus recommendations address unmet need. The RAND-modified Delphi method was used generate 20 statements few key as follows: (1) first-line setting, there no role auto-HCT consolidation achieving complete remission (CR) following R-CHOP (rituximab, cyclophosphamide, adriamycin, vincristine, prednisone) or similar non-double-hit/triple-hit cases (DHL/THL) DHL/THL receiving intensive induction therapies, but may be considered eligible cases; (2) thiotepa-based conditioning care primary central nervous system CR therapy; (3) preferred option therapy, whereas late (>12 months), recommended chemosensitivity salvage (complete partial response), those not remission. These clinical practice will serve tool guide clinicians managing newly diagnosed DLBCL.