Autologous hematopoietic stem cell transplantation (auto-HSCT) is the standard of care for patients with diffuse large B-cell lymphoma (DLBCL) who relapse/progress after first line chemoimmunotherapy. Long-term outcome of those who relapse after transplant is poor. We present the results of a retrospective study of 256 adult patients reported to the EBMT registry with DLBCL who relapsed after auto-HSCT performed between 2003 and 2013, and who received active salvage strategies. One hundred and fifty-four (60%) were male; median age was 53 years. Median time to relapse was 7 months, 65% relapsed during the first year. Overall response rate after salvage therapy was 46%. Median follow-up after first salvage therapy was 40 months (IQR 23-63 months). Overall survival (OS) at 3 years was 27% (95% CI 22-33). OS at 3 years of patients relapsing longer than 1 year after auto-HSCT was 41% (95% CI 31-53) compared with 20% (95% CI 14-24) in those who relapsed in less than 1 year. Eighty-two patients (32%) had a second HSCT, an allogeneic HSCT (allo-HSCT) in 69 cases, at a median time of 6.5 months after relapse. OS at 3 years after allo-HSCT was 36% (95% CI 25-51). In conclusion, the prognosis of patients with DLBCL that relapse after auto-HSCT is dismal. Patients who relapse in less than 1 year remain an unmet need, and should be considered for CAR T cell therapy or clinical trials. Patients who relapse after 1 year can be rescued with salvage therapies and a second HSCT. These results provide a benchmark to compare data of new prospective studies.

1st Charles University General Hospital Prague Czech Republic

Centro di Riferimento Oncologico Aviano Italy

Department of Hematology and Oncology University Hospital Brno Brno Czech Republic

Department of Hematology Hopital A Michallon Grenoble FRA France

Department of Hematology Hospital Universitario Marqués de Valdecilla Santander Spain

Department of Hematology Nottingham University Hospitals NHS Trust Nottingham UK

Department of Hematology Oncology Hemostaseology and Stem Cell Transplantation University Hospital RWTH Aachen University Aachen Germany

Department of Hematology University Hospital Gasthuisberg Dept of Hematology Leuven Belgium

Department of Medicine 5 University of Heidelberg Heidelberg Germany

Department of Medicine Kuopio University Hospital Kuopio Finland

Department of Molecular Biotechnology and Health Sciences AOU Città della Salute e della Scienza University of Torino Torino Italy

EBMT Paris Study Office Paris France

Gazi University Faculty of Medicine Ankara Turkey

Haemato Oncology Department St Bartholomew's Hospital Barts Health NHS Trust London UK

Hematology Department and HCT Unit G Papanikolaou Hospital Thessaloniki Greece

Hospital de la Santa Creu i Sant Pau Clinical Hematology Service Barcelona Spain

Institut Català d'Oncologia Hospital Duran i Reynals IDIBELL Barcelona Spain

Institut Paoli Calmettes Department of Hematology Marseille France

Papa Giovanni XXIII Hospital Bergamo Italy

Section of Hematology Cliniques Universitaires Saint Luc Brussels Belgium

Service D'Hématologie Et Thérapie Cellulaire Hopital de La Milétrie Poitiers France

Sheffield Teaching Hospitals Sheffield UK

Siunsote North Carelia Hospital District Joensuu Finland

St István and St Laszlo Hospital Budapest Hungary

St James Hospital and Trinity College Dublin Dublin Ireland

Turku University Hospital Stem Cell Transplantation Unit Turku Finland

University of Antwerp Antwerp University Hospital Dept of Hematology Antwerp Belgium

University of Eastern Finland Institute of Clinical Medicine Internal Medicine Kuopio Finland

University of Saarland Homburg Germany

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