对于完成一线治疗≥12 个月后健康状况良好的复发性弥漫性大 B 细胞淋巴瘤 (DLBCL) 患者的护理标准 (SOC) 是挽救性化疗 (ST)，然后进行自体干细胞移植 (ASCT)。然而，对于具有某些临床特征的患者来说，这种策略可能不是最佳的。我们回顾性研究了 151 例在 R-CHOP 或 R-CHOP 类一线治疗后复发≥12 个月的 DLBCL 患者，这些患者于 2000 年 7 月至 2017 年 12 月期间在梅奥诊所或 2003 年 4 月至 2020 年 4 月期间在爱荷华大学接受了 ST 和 ASCT。提取临床特征、治疗信息和结果数据。使用 Kaplan-Meier 方法分析自 ASCT 起的无进展生存期 (PFS) 和总生存期 (OS)。从一线治疗完成到第一次复发的中位时间为 26.9 个月。 ST 中线为 1（范围 1-3），17 名（11%）患者需要 >1 线 ST。 ASCT 前的最佳缓解为 60 名 (40%) 患者部分缓解 (PR)，91 名 (60%) 患者完全缓解 (CR)。 ASCT 的中位年龄为 64 岁（范围 19-78），其中 36 名（24%）患者年龄≥70 岁。 ASCT 后的中位随访时间为 87.3 个月。中位 PFS 和 OS 分别为 54.5 个月和 88.9 个月。根据 ASCT 年龄（包括年龄≥70-78 岁的患者）、性别、移植时代、复发时间、LDH、结外部位受累以及复发时中枢神经系统/神经受累，PFS 和 OS 没有显着差异。然而，晚期复发患者的 PFS 低于早期复发患者（中位 45.3 个月 vs 124.7 个月，P=0.045）。与需要 1 行 ST 的患者相比，需要 > 1 行 ST 的患者的 PFS（中位 6.1 个月与 61.4 个月，P <0.0001）和 OS（17.8 个月与 111.7 个月，P=0.0004）显着较差。获得 PR 与 CR 的患者的生存率没有统计学上的显着差异，尽管前者在数量上较差，中位 PFS 为 38.9 个月 vs 59.3 个月（P=0.23），中位 OS 为 78.3 个月 vs 111.7 个月（P=0.62）。 1 行 ST 后达到 CR 的患者具有出色的 ASCT 后结局，中位 PFS 为 63.7 个月。总之，对于需要1线以上ST才能达到PR或CR的晚期复发DLBCL（≥12个月）患者，ASCT后生存不利，此类患者应接受替代疗法。相反，仅需要 1 行 ST 的患者的生存率较高，支持了这些患者目前 ASCT 巩固的临床实践。此外，年龄≥70-78 岁的患者在 ASCT 中的结果良好，与年轻患者相似，凸显了这种方法在此类患者中的安全性和可行性。版权所有 © 2024。由 Elsevier Inc. 出版。

The standard of care (SOC) for fit patients with relapsed diffuse large B-cell lymphoma (DLBCL) ≥12 months after completing frontline therapy is salvage chemotherapy (ST) followed by autologous stem cell transplant (ASCT). However, this strategy may not be optimal for patients with certain clinical characteristics. We retrospectively studied 151 patients with DLBCL that relapsed ≥12 months after R-CHOP or R-CHOP-like frontline therapy who underwent ST and ASCT at Mayo Clinic between July 2000 and December 2017 or the University of Iowa between April 2003 and April 2020. Clinical characteristics, treatment information, and outcome data were abstracted. Progression-free survival (PFS) and overall survival (OS) from the time of ASCT were analyzed using the Kaplan-Meier method. The median time from frontline therapy completion to 1st relapse was 26.9 months. The median line of ST was 1 (range 1-3), and 17 (11%) patients required >1 line of ST. Best response before ASCT was partial response (PR) in 60 (40%) and complete response (CR) in 91 (60%) patients. The median age at ASCT was 64 years (range 19-78), and 36 (24%) patients were of ≥70 years. The median follow-up after ASCT was 87.3 months. The median PFS and OS were 54.5 and 88.9 months, respectively. There was no significant difference in PFS and OS based on the age at ASCT (including patients aged ≥70-78 years), sex, transplant era, time to relapse, LDH, extranodal site involvement, and central nervous system/nerve involvement at relapse. However, patients with advanced-stage relapse had inferior PFS than those with early-stage relapse (median 45.3 vs 124.7 months, P=0.045). Patients who required > 1 line of ST, compared to those requiring 1 line, had significantly inferior PFS (median 6.1 vs 61.4 months, P <0.0001) and OS (17.8 vs 111.7 months, P=0.0004). There was no statistically significant difference in survival in patients who achieved PR vs CR, though numerically inferior in the former, with median PFS of 38.9 vs 59.3 months (P=0.23) and median OS of 78.3 vs 111.7 months (P=0.62). Patients achieving CR after 1 line of ST had excellent post-ASCT outcomes, with median PFS of 63.7 months. In conclusion, survival after ASCT was unfavorable in patients with late relapsed DLBCL (≥12 months) who required more than 1 line of ST to achieve PR or CR, and such patients should be treated with alternative therapies. Conversely, survival was favorable in patients who required only 1 line of ST, supporting the current clinical practice of ASCT consolidation in these patients. Moreover, outcomes were favorable in patients aged ≥70-78 years at ASCT, similar to younger patients, highlighting the safety and feasibility of this approach in such patients.Copyright © 2024. Published by Elsevier Inc.