自 20 世纪 90 年代以来，治疗复发/难治性弥漫性大 B 细胞淋巴瘤 (DLBCL) 的标准治疗方法是对接受化疗的患者进行挽救性化疗，然后进行高剂量化疗和自体干细胞移植 (HDT-ASCT)。敏感缓解。然而，最近的 TRANSFORM 和 ZUMA-7 试验评估了 CAR T 细胞疗法与 HDT-ASCT 对于二线复发/难治性 DLBCL 的疗效，取得了令人鼓舞的结果，试图挑战这种护理标准。虽然这些研究为早期复发和原发性难治性 DLBCL 的治疗建立了新标准，但这些研究之间试验设计的显着差异以及病程中随机化时间的限制需要对结果进行深思熟虑的解释。此外，CAR T 细胞管理的财务负担和后勤挑战以及获得这些疗法的机会有限仍然是持续存在的问题。尽管这些试验取得了令人鼓舞的结果，HDT-ASCT 在 DLBCL 的治疗中仍然发挥着作用，特别是在初始治疗后≥12个月的疾病复发，以及对挽救性化疗有良好反应的化疗敏感疾病中。正在进行的研究评估 HDT-ASCT 之前使用的新型挽救方案，以及未来评估 CAR T 细胞疗法在化疗敏感疾病中的作用的研究将有助于确定 HDT-ASCT 对于复发/难治性 DLBCL 的持续作用。版权所有 © 2024作者。由爱思唯尔公司出版。保留所有权利。

Since the 1990s, the standard of care for the treatment of relapsed/refractory diffuse large B-cell lymphoma (DLBCL) had been salvage chemotherapy followed by high-dose chemotherapy and autologous stem cell transplantation (HDT-ASCT) in patients with a chemotherapy-sensitive remission. However, promising results from the recent TRANSFORM and ZUMA-7 trials evaluating the efficacy of CAR T-cell therapy versus HDT-ASCT for second line relapsed/refractory DLBCL have sought to challenge this standard of care. While these studies have established a new standard for the treatment of early relapsed and primary refractory DLBCL, significant differences in the trial design between these studies and limitations with the timing of randomization during the disease course warrant a thoughtful interpretation of the results. Additionally, the financial burden and logistic challenges of CAR T-cell administration and limited access to these therapies continue to be ongoing issues. Despite the encouraging results from these trials, HDT-ASCT continues to have a role in the treatment of DLBCL, especially in disease relapsing ≥12 months after initial therapy, and in chemo sensitive disease with a good response to salvage chemotherapy. Ongoing studies evaluating novel salvage regimens for use prior to HDT-ASCT, and future studies evaluating the role of CAR T-cell therapy in chemo sensitive disease will help determine the continued role of HDT-ASCT for relapsed/refractory DLBCL.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.