CAR T-Cell Therapy Viable Option for Majority of Real-World DLBCL Patients

The majority of patients with diffuse large B-cell lymphoma (DLBCL) would have been eligible for treatment with chimeric antigen receptor (CAR) T-cell therapy, according to the results of a single center retrospective study presented at the 60th ASH Annual Meeting and Exposition.

Patients with DLBCL who experience relapse or refractory disease may undergo treatment with hematopoietic cell transplantation, but about 50% of patients are ineligible because of a lack of response to chemoimmunotherapy or comorbidities. For these patients, CAR T-cell therapy may be an alternative treatment option, but real-world data are lacking on the use of CAR T-cell therapy in patients with DLBCL.

Researchers led by Neil Bailey, MSc, of the Swedish Cancer Institute (SCI), Seattle, used electronic medical records to identify 486 patients with a recorded DLBCL diagnosis who had an outpatient visit at a SCI facility between January 1, 2014, and January 1, 2018. Of these patients, 60 had prior first-line anthracycline therapy at SCI and received second-line or beyond therapy at SCI.

The investigators then determined CAR T-cell therapy eligibility based on inclusion and exclusion criteria from the ZUMA-1 clinical trial—an ongoing, multicenter, phase I/II study evaluating axicabtagene ciloleucel in patients with refractory, aggressive non-Hodgkin lymphoma. Forty-nine patients (82%) met all inclusion and exclusion criteria for CAR T-cell therapy. Patients had a median age of 61 years (range = 28–74 years) and received a median of three prior therapies; 23 patients (47%) had undergone transplant as second-line or subsequent therapy.

Patients deemed eligible for CAR T-cell therapy had an overall survival (OS) of 37.1% at 24 months. At 24 months, CAR T-cell eligible patients who underwent transplant in the second-line or subsequent setting had significantly better OS compared to those who did not (61.6% vs. 12.0%; P<.001).

The findings suggest “that the majority of the patients with relapsed or refractory DLBCL in the real world may have an opportunity to receive CAR T-cell therapy,” according to the researchers.