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Abstract Autologous stem‐cell transplantation (ASCT) is standard therapy for relapsed/refractory large B‐cell lymphoma (R/R LBCL), but many patients are either ineligible or unable to receive it. This retrospective study characterized outcomes in R/R LBCL, delineated by eligibility for, and receipt of, ASCT. Median progression‐free survival (PFS) and event‐free survival (EFS) for patients undergoing ASCT were 35.2 and 31.6 months (overall survival [OS] not reached). Median PFS, EFS, and OS were 4.3, 4.3, and 6.9 months for ineligible patients, and 2.7, 2.6, and 9.4 months for those eligible for but unable to receive ASCT. This highlights an unmet need for alternative therapies in patients unable to receive ASCT.

Abstract Over 60% of relapsed/refractory (R/R) large B‐cell lymphoma (LBCL) patients who receive chimeric antigen receptor (CAR) T cells will experience disease progression. There is no standard next line of therapy and information in this setting is scarce and heterogeneous. We analyzed 387 R/R LBCL patients who progressed after CAR T cells from July 2018 until March 2022 in Spain and the United Kingdom. Median overall survival (OS) was 5.3 months, with significant differences according to the interval between infusion and progression (6 months [not reached]). After progression, 237 (61%) patients received treatment. Focusing on the first subsequent therapy, overall (complete) response rates were 67% (38%) for polatuzumab–bendamustine–rituximab (POLA), 51% (36%) for bispecific antibodies (BsAb), 45% (35%) for radiotherapy (RT), 33% (26%) for immune checkpoint inhibitors (ICIs), 25% (0%) for lenalidomide (LENA), and 25% (14%) for chemotherapy (CT). In terms of survival, 12‐month progression‐free survival and OS was 36.2% and 51.0% for POLA, 32.0% and 50.1% for BsAb, 30.8% and 37.5% for RT, 29.9% and 27.8% for ICI, 7.3% and 20.8% for LENA, and 6.1% and 18.3% for CT. Thirty‐two (14%) patients received an allogeneic hematopoietic cell transplant with median OS not reached after a median follow‐up of 15.1 months. In conclusion, patients with R/R LBCL who progress within the first 2 months after CAR T‐cell therapy have dismal outcomes. Novel targeted agents, such as polatuzumab and BsAbs, can achieve prolonged survival after CAR T‐cell therapy failure.

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