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EBMT 2025 | The changing role of transplant in LBCL in the era of novel immunotherapies
Alberto Mussetti, MD, Institut Catala d’Oncologia Hospitalet, Barcelona, Spain, discusses the changing role of stem cell transplantation (SCT) for large B-cell lymphoma (LBCL) with the advent of novel therapies. Dr Mussetti notes that the use of autologous transplantation has decreased in the second-line setting with the approval of anti-CD19 CAR T-cells, but may still play a role in the future as the treatment landscape evolves. Meanwhile, allogeneic transplantation remains a viable option for patients relapsing after CAR T-cell therapy, especially if a response can be re-induced with novel therapies. This interview took place at the 51st Annual Meeting of the EBMT in Florence, Italy.
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Transcript
So here I think that we can distinguish between autologous stem cell transplantation and allogeneic transplantation. Now with the arrival of anti-CD19 CAR T-cells in the second line of therapy, the role of autologous cell transplantation has decreased, also because in this setting the CAR T-cells were approved especially for patients refractory to chemotherapy. So autologous stem cell transplantation is basically high-dose chemotherapy...
So here I think that we can distinguish between autologous stem cell transplantation and allogeneic transplantation. Now with the arrival of anti-CD19 CAR T-cells in the second line of therapy, the role of autologous cell transplantation has decreased, also because in this setting the CAR T-cells were approved especially for patients refractory to chemotherapy. So autologous stem cell transplantation is basically high-dose chemotherapy. Ideally, it would not make sense to offer an autologous stem cell transplantation after failure of CAR-T in the second line because the patient was chemorefractory. But you know the role and efficacy of stem cell transplantation depends on the response that you are reaching with a previous therapy. So it is possible also that in the future with newer second-line chemo or immuno-chemotherapies, possibly the role of autologous cell transplantation could be taken into consideration also in the future. I don’t know, but this is a very interesting question for the future.
While allogeneic transplantation, as we show and from other reports also at this meeting, the EBMT 2025, is still a strategy that we should consider for patients relapsing after CAR T-cell therapy, especially if you can re-induce a response, a partial or complete response with newer therapies. So in that sense, I think that today maybe allogeneic transplant also has diminished, I mean in terms of numbers, but it still has a clear role for large B-cell lymphoma. I cannot say the same thing for autologous transplantation, especially for high-risk patients, those who have received CAR-T in the second line of therapy, where possibly such a strategy is not considered in the salvage therapy consolidation because most of them are refractory patients. But newer studies are needed in the future. Maybe, as observed in Hodgkin lymphoma, we can delay the use of autologous transplantation not in the second line, but maybe in further lines of therapy if a response is achieved.
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Disclosures
Honoraria for lectures: Takeda, BMS, Gilead, Sanofi; Honoraria for advisory board activities: Merck, Jazz Pharma; Participation in clinical trials (PI): Atara, Takeda; Research funding: Gilead.
