Outcomes for CART as 2L vs 3L vs 4L or beyond in aggressive B-cell lymphoma: real-world evidence from the ABC Consortium
Year: 2025
Type: article
Study design: Observational Study
Abstract: ABSTRACT: Chimeric antigen receptor T-cell (CART) therapy has transformed the management of relapsed and refractory large B-cell lymphoma (LBCL), but real-world outcomes data is needed to confirm the benefits seen in clinical trial settings. We performed a multicenter retrospective analysis evaluating CART therapy outcomes according to line of therapy, specifically second line (2L) vs third line (3L) vs fourth line (4L) and beyond (4L+). We included patients who received CD19-directed CART therapy for de novo diffuse LBCL or transformed follicular lymphoma. Overall (N = 466), 21% (n = 98) of patients received CART as 2L, 41% (n = 192) as 3L, and 38% (n = 176) as 4L+. Median follow-up from CART infusion was 35 months. Overall response rate and complete response rate were similar for 2L vs 3L vs 4L+. From CART infusion, median progression-free survival (mPFS) and median overall survival (mOS) were similar for 2L vs 3L, but shorter in patients receiving CART as 4L+ (mPFS, 11.6 vs 12.7 vs 5.7 months, P< .001; mOS, not reached vs 69.4 vs 21.9 months, P< .001). In patients with double-hit or triple-hit lymphoma (DHL/THL), receiving CART in 2L vs 3L significantly improved 3-year OS (63% [2L] vs 32% [3L], P = .01). Patients with disease that required bridging therapy were also at increased risk of progression or death. Overall, our findings inform real-world practice wherein CART therapy as 2L vs 3L yields similar survival outcomes in unselected patients. However, patients specifically with DHL/THL should be considered for CART therapy in the 2L outside of the primary refractory disease (PRD) or early relapsed setting.
Source: Blood Advances
Authors: John S. Wang, Brandon L. Ellsworth, Megan Melody, Narendranath Epperla, Deborah Stephens, Jason Romancik, Matthew Cortese, Rahul Bhansali, Tamara K. Moyo, Vaishalee Kenkre, Thomas Ollila, Brian Hess, Lindsey Fitzgerald, Geoffrey Shouse, Matthew Matasar, Megan M. Herr, James Davis, Christy Jesme, Ari R. Pelcovits, Jonathan Moreira, Adam Y. Lin, Shuo Ma, Jane N. Winter, Alexey V. Danilov, Nirav N. Shah, Stefan K. Barta, Jonathon B. Cohen, Leo I. Gordon, Natalie Grover, Reem Karmali
Institutions: Northwestern University, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Huntsman Cancer Institute, The Ohio State University, University of North Carolina at Chapel Hill, Emory University, Winship Cancer Institute, Roswell Park Comprehensive Cancer Center, Hospital of the University of Pennsylvania, Abramson Cancer Center, University of Pennsylvania, Carolinas Medical Center, Levine Cancer Institute, University of Wisconsin–Madison, University of Wisconsin Carbone Cancer Center, Brown University, Lifespan, Medical University of South Carolina, MUSC Hollings Cancer Center, University of Utah, City Of Hope National Medical Center, City of Hope, Rutgers, The State University of New Jersey, Rutgers Cancer Institute, Medical College of Wisconsin, Medical College of Wisconsin Cancer Center, UNC Lineberger Comprehensive Cancer Center
Language: English
Topic: CAR-T cell therapy research
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,800
OpenAlex ID: W4416009712