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:
Notes: Article -- Export Date: 2 November 2020 -- Source: Scopus
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MSK Authors
  1. Joachim Yahalom
    635 Yahalom
  2. Ariela Noy
    374 Noy
  3. Maria Lia Palomba
    448 Palomba
  4. Steven M Horwitz
    671 Horwitz
  5. Craig Steven Sauter
    336 Sauter
  6. Andrew D Zelenetz
    785 Zelenetz
  7. Miguel-Angel Perales
    946 Perales
  8. Alison Moskowitz
    362 Moskowitz
  9. Paul Hamlin
    294 Hamlin
  10. Matthew J Matasar
    293 Matasar
  11. Philip C Caron
    102 Caron
  12. David J Straus
    361 Straus
  13. Anita Kumar
    202 Kumar
  14. Sean McCarthy Devlin
    618 Devlin
  15. Parastoo Bahrami Dahi
    305 Dahi
  16. Michael Scordo
    389 Scordo
  17. Connie Wing-Ching Lee Batlevi
    177 Batlevi
  18. Anas Younes
    320 Younes
  19. Colette Ngozi Owens
    81 Owens
  20. Gunjan Lalitchandra Shah
    450 Shah
  21. Caleb   Ho
    73 Ho
  22. Erel Joffe
    85 Joffe
  23. Richard Jirui Lin
    132 Lin
  24. Aishat Olaide Afuye
    16 Afuye
  25. Jessica Flynn
    183 Flynn
  26. David Sermer
    12 Sermer
  27. Martina Pennisi
    25 Pennisi
  28. Lorenzo Falchi
    137 Falchi