Real-World Eligibility for Second-Line Chimeric Antigen Receptor T Cell Therapy in Large B Cell Lymphoma: A Population-Based Analysis

Abstract

The ZUMA-7 trial demonstrated the superiority of second-line chimeric antigen receptor (CAR) T cell therapy over standard of care chemotherapy with or without autologous stem cell transplantation (ASCT) for relapsed/refractory (r/r) large B cell lymphoma (LBCL). We conducted a retrospective population-based analysis to determine eligibility for second-line CAR-T cell therapy in the real-world setting. Among 125 patients with r/r LBCL between 2015 and 2019, 82% progressed within 12 months of first-line chemoimmunotherapy (CIT), 40% were treated with intention-to-transplantation, 22% underwent ASCT, and 7% achieved a durable remission after ASCT. With a median follow-up of 2.8 years, the median overall survival (OS) was 5.1 months, and 3-year OS was 15% (95% confidence interval [CI], 7% to 20%) for all patients and 10% (95% CI, 5% to 17%) for those progressing within 12 months of CIT. Although only 14% of patients met all the ZUMA-7 study inclusion criteria, as many as 65% of patients progressing within 12 months of CIT had adequate performance status to be considered potentially eligible for second-line CAR T cell therapy. Whereas the current standard of care results in poor outcomes for most patients with r/r LBCL, the use of CAR T cell therapy in second-line therapy could substantially increase the proportion of patients able to receive curative-intent treatment at first progression of LBCL.

Keywords: Autologous stem cell transplantation; CAR T cell therapy; Large B cell lymphoma; Relapsed.