EHA 2025 | The role of alloSCT for R/R DLBCL in the era of CAR-T and bispecifics

I would say that the role of allogeneic stem cell transplantation in the treatment of relapsed or refractory large cell lymphoma is very much in evolution. Certainly before we had CAR-T and bispecifics for patients with multiple relapsed large cell lymphoma, particularly who had been failed by a prior autologous stem cell transplant or autotransplant, allo remained the only treatment with curative potential. And we were often willing to accept the risks of treatment-related mortality with an allotransplant in pursuit of that offer of cure. In the era of CAR T-cell therapy and now bispecifics, where we have treatments that in the case of CAR T-cell therapy have proven curative potential, and in the case of bispecifics, very active treatment that may or may not hold a curative potential. The jury is still out. The timing and selection of patients to undergo allogeneic transplantation is very much indeterminate. For patients who have been treated with CAR T-cell therapy and are in ongoing remission, I think that the majority of experts are against immediately moving into consolidative allotransplant because the juice may not be worth the squeeze. Accepting the treatment-related mortality risk there, where a patient may be cured by the CAR T-cell therapy that they received may not be advantageous. The question with bispecifics is a little bit more challenging because we don’t yet know that bispecific therapy holds curative potential, so there may be a greater temptation to consolidate response to a bispecific with an allogeneic transplant in a younger, fitter patient. At this point, we don’t have key data that we need to make that policy stance programmatically across the board for large cell lymphoma. So this remains an individualized discussion between oncologist, transplanter, and patient weighing the risks and benefits, taking into account other treatment options available and patients’ goals and preferences, as well as their own age comorbidities and individualized risk prognostically in terms of their ability to tolerate an allotransplant. I think we’re going to get greater clarity over these next years, and hopefully we’ll arrive at a steadier state where we know who, if anybody really does need an allotransplant, or should it be restricted to patients who have been failed by both CAR-T and bispecifics.

This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.