Do all roads lead to Rome? The heterogeneity of relapsed/refractory diffuse large B-cell lymphoma patients who achieved therapies response and received autologous stem cell transplantation in the era of new targeted drugs

In this multicenter study, we aimed to identify the prognostic factors for relapsed/refractory diffuse large B-cell lymphoma (DLBCL) patients who received autologous stem cell transplantation (ASCT) in the era of novel agents and chimeric antigen receptor (CAR) T-cell therapy. A total of 82 relapsed/refractory DLBCL patients receiving ASCT across four transplant centers were enrolled. The 3-year probabilities of disease progression, non-relapse mortality (NRM), progression-free survival (PFS), and overall survival (OS) were 23.5%, 2.8%, 73.7%, and 91.4%, respectively. Patients who received Pola-R-CHP before ASCT had a higher disease progression rate (85.7% <i>vs.</i> 18.4%, <i>P</i> = 0.034) and a poorer PFS (0% <i>vs.</i> 79.9%, <i>P</i> < 0.001) after ASCT compared with those who did not receive Pola-R-CHP. Patients who received BTKi before ASCT had a higher disease progression rate (60.0% <i>vs.</i> 18.2%, <i>P</i> = 0.025) and a poorer PFS rate (23.8% <i>vs.</i> 81.8%, <i>P</i> < 0.001) after ASCT compared with those who did not receive BTKi. In multivariate analysis, receiving novel agents before ASCT was independently associated with a higher risk of disease progression and worse PFS. In summary, we observed the heterogeneity of relapsed/refractory DLBCL patients who achieved therapies response and received ASCT, and some of them might not benefit from ASCT.