Patients with diffuse large B-cell lymphoma (DLBCL) often experience long-term survival after initial anthracycline-containing therapy; however, relapse leads to poor outcomes. Some patients with relapsed or refractory disease may receive additional chemoimmunotherapy followed by hematopoietic cell transplantation (HCT), but as many as 50% of patients cannot undergo HCT because of lack of response to chemoimmunotherapy or comorbidities. Chimeric antigen receptor (CAR) T-cell therapy may be an option for those patients, but real-world data on CAR T-cell therapy for DLBCL are limited.
A retrospective cohort study assessed real-world eligibility for CAR T-cell therapy and found that more than 80% of patients at the Swedish Cancer Institute in Seattle, WA, would have been deemed eligible. Neil Bailey, MSc, of the Swedish Medical Center, discussed the findings at the ASH Annual Meeting on December 1, 2018.
Researchers used electronic medical record data to identify 486 patients with a recorded DLBCL diagnosis who had an outpatient visit at a Swedish Cancer Institute facility between January 1, 2014, and January 1, 2018. The investigators then determined CAR T-cell 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 (range = 2–9 therapies); 23 patients (47%) had undergone HCT 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. Among CAR T-cell eligible patients, 47% (n = 23) underwent HCT. At 24 months, CAR T-cell eligible patients who underwent HCT in the second-line or subsequent setting had significantly better OS (61.6%) compared to those who did not undergo HCT (12.0%; p < 0.001).
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.