The value of complete remission according to positron emission tomography prior to autologous stem cell transplantation in lymphoma: a population-based study showing improved outcome

Abstract Background Chimeric antigen-receptor T-cell and bispecific antibody therapies will likely necessitate a reconsideration of the role autologous stem-cell transplantation (ASCT) in lymphoma. Patients who are to profit from ASCT need be better identified. Methods Here, we investigated value positron emission tomography/computerized tomography (PET/CT) before ASCT. All 521 patients transplanted for lymphoma 1994–2019 at Karolinska (497 conditioned with BEAM) were included. Results Outcome improved over three calendar periods 1994–2004, 2005–2014, 2015–2019 (2-year overall survival [OS]: 66, 73, 83%; P = 0.018). Non-relapse mortality (NRM) 100 days 9.8, 3.9, 2.9%, respectively. The OS improvement between 1994 2004 2005–2014 was due lower NRM ( 0.027), but large advance 2015 not accompanied by significant reduction 0.6). fraction PET/CT as pre-ASCT assessment also increased time: 2%; 24%; 2015–2019, 60% < 0.00005). Complete responses (PET/CT-CR) observed 77% metabolically active partial (PET/CT-PR) 23%. PET/CT-CR predictor entire population 0.0003), subpopulations aggressive B-cell 0.004) peripheral 0.024) lymphomas. Two-year progression-free (OS/PFS) relapsed/refractory 87%/75% 91%/78%. corresponding figures PET/CT-PR 43%/44 33%/33%. solitary PET/CT-positive lesions showed acceptable outcome followed local irradiation OS/PFS 80%/60%). CT less discriminative: 2-year OS/PFS: CT-CR, 76%/66%; CT-PR, 62%/51%. inferior after BEAC compared BEAM conditioning. Conclusions We conclude that reflects better, PET/CT-informed, identification should proceed excellent indicates remain part standard therapy