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. 2020 Dec 22;4(24):6157-6168.
doi: 10.1182/bloodadvances.2020003036.

CAR T cells or allogeneic transplantation as standard of care for advanced large B-cell lymphoma: an intent-to-treat comparison

Peter Dreger  1 , Sascha Dietrich  1 , Maria-Luisa Schubert  1 , Lorenz Selberg  1 , Andrea Bondong  1 , Mandy Wegner  1 , Peter Stadtherr  1 , Christoph Kimmich  1 , Florentina Kosely  1 , Anita Schmitt  1 , Petra Pavel  2 , Nora Liebers  1 , Thomas Luft  1 , Ute Hegenbart  1 , Aleksandar Radujkovic  1 , Anthony Dick Ho  1 , Carsten Müller-Tidow  1 , Michael Schmitt  1
Affiliations

CAR T cells or allogeneic transplantation as standard of care for advanced large B-cell lymphoma: an intent-to-treat comparison

Peter Dreger et al. Blood Adv. .

Abstract

CD19-directed chimeric antigen receptor (CAR) T-cell treatment has evolved as standard of care (SOC) for multiply relapsed/refractory (R/R) large B-cell lymphoma (LBCL). However, its potential benefit over allogeneic hematopoietic cell transplantation (alloHCT) remains unclear. We compared outcomes with both types of cellular immunotherapy (CI) by intention to treat (ITT). Eligble were all patients with R/R LBCL and institutional tumor board decision recommending SOC CAR T-cell treatment between July 2018 and February 2020, or alloHCT between January 2004 and February 2020. Primary end point was overall survival (OS) from indication. Altogether, 41 and 60 patients for whom CAR T cells and alloHCT were intended, respectively, were included. In both cohorts, virtually all patients had active disease at indication. CI was recommended as part of second-line therapy for 21 alloHCT patients but no CAR T-cell patients. Median OS from indication was 475 days with CAR T cells vs 285 days with alloHCT (P = .88) and 222 days for 39 patients for whom alloHCT beyond second line was recommended (P = .08). Of CAR T-cell and alloHCT patients, 73% and 65%, respectively, proceeded to CI. After CI, 12-month estimates for nonrelapse mortality, relapse incidence, progression-free survival, and OS for CAR T cells vs alloHCT were 3% vs 21% (P = .04), 59% vs 44% (P = .12), 39% vs 33% (P = .97), and 68% vs 54% (P = .32), respectively. In conclusion, CAR T-cell outcomes were not inferior to alloHCT outcomes, whether measured by ITT or from CI administration, supporting strategies preferring CAR T cells over alloHCT as first CI for multiply R/R LBCL.

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Conflict of interest statement

Conflict-of-interest disclosure: P.D. reports consultancy for AbbVie, AstraZeneca, Gilead, Janssen, Novartis, Riemser, and Roche; speakers’ bureau for AbbVie, Gilead, Novartis, Riemser, and Roche; and research support from Neovii and Riemser. C.K. reports advisory board membership for Gilead. M.S. reports research grants from Apogenix, Hexal, and Novartis; travel grants from Hexal and Kite; financial support for educational activities and conferences from bluebird bio, Kite, and Novartis; and advisory board membership for Merck Sharp & Dohme and is co–principal investigator of clinical trials for Merck Sharp & Dohme, GlaxoSmithKline, Kite, and Bristol-Myers Squibb and cofounder and shareholder of TolerogenixX Ltd. A.S. reports travel grants from Hexal and Jazz Pharmaceuticals and a research grant from Therakos/Mallinckrodt and is cofounder and part-time employee of TolerogenixX LtD. The remaining authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
OS from CI indication by CI intended. (A) CAR T-cell candidates vs all alloHCT candidates. (B) CAR T-cell candidates vs alloHCT candidates for whom ≥2 lines had failed (≥2L) at indication.
Figure 2.
Figure 2.
Outcomes from CI administration by CI actually received. (A-D) CAR T-cell recipients vs all alloHCT patients. (E-H) CAR T-cell recipients vs alloHCT patients for whom alloHCT was intended after failure of ≥2L. (A,E) OS. (B,F) PFS. (C,G) Incidence of relapse/progression. (D,H) NRM. Note that all CAR T-cell applications were intended after failure of ≥2L.
See this image and copyright information in PMC

References

    1. Van Den Neste E, Schmitz N, Mounier N, et al. Outcome of patients with relapsed diffuse large B-cell lymphoma who fail second-line salvage regimens in the International CORAL study. Bone Marrow Transplant. 2016;51(1):51-57. - PubMed
    1. Crump M, Neelapu SS, Farooq U, et al. Outcomes in refractory diffuse large B-cell lymphoma: results from the international SCHOLAR-1 study [published correction appears in Blood. 2018;131(5):587-588]. Blood. 2017;130(16):1800-1808. - PMC - PubMed
    1. González-Barca E, Boumendil A, Blaise D, et al. Outcome in patients with diffuse large B-cell lymphoma who relapse after autologous stem cell transplantation and receive active therapy. A retrospective analysis of the Lymphoma Working Party of the European Society for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant. 2020;55(2):393-399. - PubMed
    1. Epperla N, Badar T, Szabo A, et al. Postrelapse survival in diffuse large B-cell lymphoma after therapy failure following autologous transplantation. Blood Adv. 2019;3(11):1661-1669. - PMC - PubMed
    1. Tilly H, Gomes da Silva M, Vitolo U, et al. ; ESMO Guidelines Committee . Diffuse large B-cell lymphoma (DLBCL): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015;26(suppl 5):v116-v125. - PubMed

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