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Hematopoietic-cell transplantation for lymphoma in the era of genetically engineered cellular therapy

it's not quite time to scrap the old vehicle for the new car

Scordo, Michaela,b; Lin, Richard J.a; Sauter, Craig S.a,b

Current Opinion in Hematology: July 2019 - Volume 26 - Issue 4 - p 288–293
doi: 10.1097/MOH.0000000000000515
LYMPHOID BIOLOGY AND DISEASES: Edited by Ari M. Melnick
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Purpose of review Second-line platinum-based salvage chemotherapy followed by high-dose chemotherapy and autologous hematopoietic-cell transplantation (AHCT) has remained the standard of care (SOC) for relapsed and primary refractory (r/r) diffuse large B-cell lymphoma (DLBCL) for greater than 2 decades. In the postrituximab era, this strategy has yielded disappointing outcomes for r/r patients with curability in less one-quarter of the patients by intention-to-treat.

Recent findings Given the Food and Drug Administration (FDA) approval of chimeric antigen receptor (CAR) modified T cells directed against CD19 (CD19 CAR T) for DLBCL following two lines of therapy and/or failed AHCT, encouragement with this therapy in the second line for r/r patients has naturally prompted randomized phase III studies against the aforementioned SOC. The predominant hurdle to procession to AHCT is chemotherapy sensitivity after platinum-based salvage therapy.

Summary In this review, we will discuss recent investigations to improve response rates in r/r DLBCL with the intent of proceeding to potentially curative AHCT, as well as investigations to decrease progression post-AHCT. In addition, data regarding currently FDA approved CD19 CAR T cells will be reviewed. Within 2–3 years, we will know if the multicenter/multinational studies of CD19 CAR T will replace SOC salvage therapy and AHCT in the second-line. The role of allogeneic HCT will also be briefly reviewed in the context of these therapies.

aAdult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center

bDepartment of Medicine, Weill Cornell Medical College, New York, New York, USA

Correspondence to Michael Scordo, MD, Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. Tel: +1 212 639 6052; e-mail: scordom@mskcc.org

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