Modified Conditioning Regimen MCE in Upfront HSCT Provides a Substantial Survival Benefit in High-risk DLBCL

Abstract Background: High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (ASCT) remains controversial as a front-line therapy for high-risk diffuse large B cell lymphoma (DLBCL). Moreover, whether modifying the conditioning regimen with anthracyclines for DLBCL will improve the effect and achieve a deeper response in upfront HSCT remains unexplored. Methods: In the present study, we retrospectively compared the outcomes of 156 high-risk DLBCL patients treated with non-HSCT, upfront HSCT or salvage HSCT with a conditioning regimen consisting of mitoxantrone, etoposide, and cyclophosphamide (MCE). Result: We found that an MCE conditioning regimen achieved a complete hematopoietic engraftment and well-tolerated, the incidence of grade 1–2 cardiac toxicity was 3.1%. Transplant-related mortality did not occur. The overall survival (OS) and progression-free survival (PFS) of the upfront group (117.8 and 92.9 months) were substantially longer than that of the non-HSCT group (78.1 and 48.9 months) (P = 0.001 vs P = 0.009), also much longer than that of salvage HSCT group (58.3 m and 21.5 m) (P = 0.00 vs P = 0.00). The multivariate analysis that AnnArbor Stage was related to PFS and OS in upfront HSCT with the MCE regimen. Conclusions: The upfront HSCT with MCE regimen was well-tolerated and exhibited intriguing data in front line therapy to improve the high-risk DLBCL prognosis. However, whether high-risk DLBCL should receive consolidation HSCT with an MCE regimen after an initial CR requires a prospective, large-scale, long-term clinical trials to validate.Retrospectively registered: This study was approved by the Ethical Committee of Huadong Hospital with the Ethical number of 2021K126.