Outcomes in patients with refractory/relapsed CNS lymphoma treated in complete remission：autologous transplantation vs. CAR-T therapy

Abstract Background Autologous hematopoietic cell transplantation (ASCT) is a reasonable approach as a consolidation therapy for fit patients with chemosensitive relapsed central nervous system lymphoma (CNSL) who have achieved complete remission (CR). Chimeric antigen receptor T-cell (CAR-T) therapy is an effective treatment option for patients with relapsed CNSL, although there is limited evidence regarding the outcomes of these patients in CR. Aim To compare the efficacy of ASCT versus CAR-T therapy in patients with relapsed CNSL during CR. Methods A retrospective observational study was conducted on patients who underwent ASCT or CAR-T therapy at the Department of Lymphoma, Beijing Gobroad Hospital between 2021 and 2024. The CAR-T therapy was part of the clinical trial “Different B-cell Target CAR-T cells for relapsed/refractory CNSL (ChiCTR2200058972)”. Results Sixty patients, including 42 (70%) with primary CNSL and 18 (30%) with diffuse large B-cell lymphoma (DLBCL) presenting secondary CNS involvement, were enrolled. The median follow-up duration was 12.1 months (1.28–59.9 months). Patients who received ASCT while in CR had superior progression-free survival (PFS) [3-year PFS 80% (95% CI: 48.4–93.4) vs. 64.8% (95% CI:38.9–81.9); P = 0.026] and a lower cumulative incidence of relapse/progression [3-year relapse rate 20% (95% CI: 4.12–44.39) vs. 30.2% (95% CI: 11.0-52.2); P = 0.038] compared to patients in the CAR-T group. Conclusion Compared to CAR-T therapy, ASCT was associated with improved PFS in patients with relapsed CNSL who had achieved CR. Clinical Trials Number: ChiCTR2200058972