Outcomes in patients with DLBCL treated with commercial CAR T cells compared with alternate therapies

David Sermer, Connie Batlevi, M. Lia Palomba, Gunjan Shah, Richard J. Lin, Miguel Angel Perales, Michael Scordo, Parastoo Dahi, Martina Pennisi, Aishat Afuye, Mari Lynne Silverberg, Caleb Ho, Jessica Flynn, Sean Devlin, Philip Caron, Audrey Hamilton, Paul Hamlin, Steven Horwitz, Erel Joffe, Anita KumarMatthew Matasar, Ariela Noy, Colette Owens, Alison Moskowitz, David Straus, Gottfried von Keudell, Ildefonso Rodriguez-Rivera, Lorenzo Falchi, Andrew Zelenetz, Joachim Yahalom, Anas Younes, Craig Sauter

Research output: Contribution to journalArticlepeer-review

Abstract

The prognosis of patients with relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL) is poor. Chimeric antigen receptor (CAR) T-cell therapy has been approved for R/R DLBCL after 2 prior lines of therapy based on data from single-arm phase 2 trials, with complete responses (CRs) in 40% to 60% of patients. However, a direct comparison with other treatments is not available and, moreover, its true efficacy in real-world patients is unknown. In this single center, retrospective, observational study of 215 patients, we compared outcomes in patients treated with CAR T-cell therapy (n = 69) with a historical population treated with alternate therapies (n = 146). Patients treated with CAR T cell vs alternate therapies demonstrated a CR rate of 52% vs 22% (P<.001), median progression-free survival (PFS) of 5.2 vs 2.3 months (P =.01), and median overall survival (OS) of 19.3 vs 6.5 months (P =.006), and this advantage appeared to persist irrespective of the number of lines of prior therapy. After adjusting for unfavorable pretreatment disease characteristics, superior overall response rate in the CAR T cohort remained significant; however, differences in PFS and OS between cohorts did not. In addition, patients who responded to alternate therapies demonstrated prolonged remissions comparable to those who responded to CAR T therapy. We contend that in select clinical scenarios alternate therapies may be as efficacious as CAR T therapy; thus, additional study is warranted, ideally with randomized prospective trials.

Original languageEnglish
Pages (from-to)4669-4678
Number of pages10
JournalBlood advances
Volume4
Issue number19
DOIs
StatePublished - 13 Oct 2020
Externally publishedYes

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