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

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

Authors:	Sermer, D.; Batlevi, C.; Lia Palomba, M.; Shah, G.; Lin, R. J.; Perales, M. A.; Scordo, M.; Dahi, P.; Pennisi, M.; Afuye, A.; Silverberg, M. L.; Ho, C.; Flynn, J.; Devlin, S.; Caron, P.; Hamilton, A.; Hamlin, P.; Horwitz, S.; Joffe, E.; Kumar, A.; Matasar, M.; Noy, A.; Owens, C.; Moskowitz, A.; Straus, D.; von Keudell, G.; Rodriguez-Rivera, I.; Falchi, L.; Zelenetz, A.; Yahalom, J.; Younes, A.; Sauter, C.
Article Title:	Outcomes in patients with DLBCL treated with commercial CAR T cells compared with alternate therapies
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. © 2020 by The American Society of Hematology
Keywords:	adult; cancer survival; controlled study; treatment outcome; aged; young adult; human cell; major clinical study; overall survival; lenalidomide; prednisone; cisplatin; doxorubicin; monotherapy; treatment duration; gemcitabine; cytarabine; rituximab; progression free survival; etoposide; cohort analysis; bendamustine; cyclophosphamide; dexamethasone; vincristine; retrospective study; ifosfamide; procarbazine; cancer regression; immunological tolerance; allogeneic hematopoietic stem cell transplantation; intermethod comparison; therapy effect; alternative medicine; observational study; cd19 antigen; autologous hematopoietic stem cell transplantation; comparative effectiveness; overall response rate; diffuse large b cell lymphoma; ibrutinib; human; male; female; priority journal; article; median survival time; tisagenlecleucel t; chimeric antigen receptor t-cell immunotherapy; axicabtagene ciloleucel
Journal Title:	Blood Advances
Volume:	4
Issue:	19
ISSN:	2473-9529
Publisher:	American Society of Hematology
Date Published:	2020-10-13
Start Page:	4669
End Page:	4678
Language:	English
DOI:	10.1182/bloodadvances.2020002118
PUBMED:	33002134
PROVIDER:	scopus
PMCID:	PMC7556134
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85092281153&doi=10.1182%2fbloodadvances.2020002118&partnerID=40&md5=bc21fffd0e6d8af5939b62df612800a4
Notes:	Article -- Export Date: 2 November 2020 -- Source: Scopus