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Leo I. Gordon, MD, FACP


CAR T-Cell Therapy Versus Previous Standard of Care for Refractory Aggressive LBCL

By: Julia Fiederlein
Posted: Tuesday, September 27, 2022

Patients with refractory aggressive large B-cell lymphoma (LBCL) seemed to derive a progression-free and overall survival benefit from chimeric antigen receptor (CAR) T-cell therapy versus the previous standard of care, according to Alejandro Martín García-Sancho, MD, PhD, of Hospital Universitario de Salamanca, Spain, and colleagues. The results of this retrospective analysis, which were published in the Frontiers in Immunology, suggested the CAR T-cell product axicabtagene ciloleucel may be superior to tisagenlecleucel in terms of efficacy, although more toxic, in this real-world setting.

“To our knowledge, this is the largest study comparing CAR T-cell therapy with the previous standard of care in real-world evidence,” the investigators commented. “In addition, as far as we know, we present the first series focused on patients with refractory aggressive B-cell non-Hodgkin lymphoma according to SCHOLAR-1 criteria comparing axicabtagene ciloleucel or tisagenlecleucel in the real-world evidence setting.”

Patients fulfilling SCHOLAR-1 criteria for refractory disease who underwent commercial CAR T-cell therapy (axicabtagene ciloleucel: n = 101; tisagenlecleucel: n = 91) were compared with a historical refractory population of patients from the GELTAMO-IPI study who were treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or a more intense curative-intent regimen (n = 81). Both CAR T-cell therapy products demonstrated superior progression-free (P ≤ .001) and overall (P < .001) survival outcomes versus the previous standard of care independently of other prognostic factors (progression-free survival: hazard ratio [HR] = 0.59; overall survival: HR = 0.45).

Patients treated with axicabtagene ciloleucel experienced a longer median duration of progression-free survival (P = .027) and a higher 12-month rate of overall survival (P = .048) than those who received tisagenlecleucel. These differences were found to be maintained in the multivariable analysis. In addition, axicabtagene ciloleucel appeared to be independently associated with a higher risk of severe cytokine-release syndrome and neurotoxicity.

Disclosure: The study authors reported no conflicts of interest.

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