Search

Objectives: To evaluate the role of additional chemotherapy before autologous hematopoietic cell transplantation (HCT) in patients with relapse/refractory diffuse large B‐cell lymphoma (DLBCL) who achieve partial remission following first salvage therapy. Methods: We conducted a multicenter retrospective study of all adult patients with DLBCL who underwent HCT between 2008 and 2020 and achieved partial response (PR) after the first salvage and were either referred directly to HCT (n = 47) or received additional salvage therapy before HCT (n = 22). Results: Post‐HCT CR rate and progression‐free survival were comparable between the two groups (66% vs. 68%, p =.86 and median not reached vs. 10.2 months [95% confidence interval, CI 7.1–12.3], p =.27, respectively). Median overall survival (OS) and estimated 3‐year OS favored patients who were directly referred to HCT (105.8 [95% CI 63–148] months vs. 14.5 [95% CI 0–44] months, p =.035, and 65% [95% CI 51%–75%] vs. 40% [95% CI 21%–53%], p =.035, respectively). In Cox regression model, while International Prognostic Index and primary refractory versus relapse disease did not impact OS, allocation to a second salvage regimen and older age were both associated with inferior survival (hazard ratio [HR] = 2.57 95% CI 1.1–5.8, p =.023 and HR = 1.04 95% CI 0.99–1.2, p =.064, respectively). Conclusions: Referring patients with chemotherapy‐sensitive disease in PR directly to HCT is associated with better OS compared to those receiving additional lines of treatment. [ABSTRACT FROM AUTHOR]

Summary: Treatment with high‐dose chemotherapy followed by autologous stem cell transplantation (ASCT) is considered standard of care (SOC) second‐line treatment for relapsed or refractory large B‐cell lymphoma (LBCL). However, outcomes remain suboptimal. A systematic review and meta‐analysis of randomised controlled trials comparing efficacy and safety of SOC versus chimeric antigen receptor T‐cell (CAR‐T) therapy as second‐line for patients with LBCL refractory or relapsing within 12 months. Outcomes included overall survival (OS), event‐free survival (EFS), overall response rate (ORR) and safety. Three trials published in 2021 (involving 865 participants) fulfilled the eligibility criteria. EFS as well as OS were significantly improved with CAR‐T therapy as compared to SOC, hazard ratio (HR) 0.57 (95% confidence interval [CI] 0.49–0.68) and HR 0.77 (95% CI 0.60–0.98) respectively. CAR‐T therapy was associated with significantly better ORR, relative risk (RR) 1.55 (95% CI 1.12–2.13, p = 0.001). The risk of Grade III/IV adverse event was comparable between the two arms, RR 1.03 (95% CI 0.93–1.14). In summary, CAR‐T therapy has superior outcomes as compared to SOC in patients with LBCL refractory or relapsing within 12 months, without excess of toxicity. Longer follow‐up is needed to confirm these results and determine the optimal sequencing of CAR‐T therapy in the management of LBCL. [ABSTRACT FROM AUTHOR]

2021; 138 (Supplement 1): 91. 2 Shargian L, Raanani P, Yeshurun M, Gafter-Gvili A, Gurion R. Chimeric antigen receptor T-cell therapy is superior to standard of care as second-line therapy for large B-cell lymphoma: a systematic review and meta-analysis. Keywords: B-cell; CAR-T; CD19; chimaeric antigen receptor; diffuse large cell; lymphoma; meta-analysis; refractory relapse EN B-cell CAR-T CD19 chimaeric antigen receptor diffuse large cell lymphoma meta-analysis refractory relapse e4 e5 2 12/22/22 20230101 NES 230101 We read with interest the letter by Luis Carlos Saiz and colleagues and thank you for the opportunity to discuss some of their comments. CAR-T cell therapy is superior to standard of care as second-line therapy for large B-cell lymphoma: A systematic review and meta-analysis. [Extracted from the article]