Majority of Real-World Patients With DLBCL Are Eligible for CAR T-Cell Therapy

December 01, 2018

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.

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