According to the results of a study published in Blood Advances, both chimeric antigen receptor T-cell (CAR-T) therapy and allogeneic hematopoietic cell transplant (alloHCT) appear to provide durable remissions in a subset of patients with diffuse large B-cell lymphoma (DLBCL) who experienced relapse after prior autologous hematopoietic cell transplant (autoHCT). The researchers also demonstrated that the Center for International Blood and Marrow Transplant Research (CIBMTR) prognostic score can identify patients at high risk of treatment failure after either procedure.
Hamadani et al. conducted a retrospective, noncomparative registry analysis of outcomes of adult patients with DLBCL who experienced relapse after prior autoHCT and underwent a reduced intensity alloHCT or CAR-T therapy with axicabtagene ciloleucel between 2012 and 2019. They also applied the CIBMTR prognostic model to predict outcomes of alloHCT and CAR-T recipients. Outcomes of interest included progression-free survival (PFS), overall survival (OS), nonrelapse mortality (NRM), and relapse.
The study included 584 patients with DLBCL who received either CAR-T treatment (n = 181) or an alloHCT (n = 403) after prior autoHCT failure from the CIBMTR registry. The median age was 61.0 years (range, 21.9-80.0) in the CAR-T cohort and 56.7 years (18.5-72.9) in the alloHCT cohort (P <.01). Most patients (67.4%) in the CAR-T cohort had refractory disease, while most (80.2%) in the alloHCT cohort had chemosensitive disease (80.2%). The median follow-up duration was 13 months (range, 1.0-27.7) for the CAR-T survivors and 51.8 months (0.2-98.6) for the alloHCT survivors.
At 1 year post-treatment, the rates of relapse, NRM, OS, and PFS were 39.5%, 4.8%, 73.4%, and 55.7%, respectively, for the CAR-T cohort and 26.2%, 20.0%, 65.6%, and 53.8 % for the alloHCT cohort.
According to the CIBMTR prognostic score, 1-year OS probabilities for patients classified to low-, intermediate-, and high/very high-risk groups were 88.4%, 76.4%, and 52.8%, respectively, for the CAR-T cohort (P <.001) and 73.3%, 59.9%, and 46.3% for the of alloHCT cohort, respectively (P =.002).
“In conclusion, this noncomparative, retrospective, registry analysis shows that both CAR-T and alloHCT can provide durable remissions in a subset of patients with DLBCL relapsing after prior autoHCT,” wrote the researchers. “The simple-to-use CIBMTR prognostic score can be used to identify patients at high risk of treatment failure after either procedure in clinical practice or incorporated in the design of trials evaluating novel relapse mitigations strategies after cellular immunotherapies in patients with DLBCL with a prior autoHCT failure.”
Disclosure: This research was partially supported by the following commercial entities: AbbVie, Accenture, Actinium Pharmaceuticals, Inc., Adaptive Biotechnologies Corporation, Adienne SA, Allovir, Inc., Amgen, Inc., Astellas Pharma US, bluebird bio, inc., Bristol Myers Squibb Co., CareDx, CSL Behring, CytoSen Therapeutics, Inc., Daiichi Sankyo Co., Ltd., Eurofins Viracor, ExcellThera, Fate Therapeutics, Gamida-Cell, Ltd., Genentech Inc, Gilead, GlaxoSmithKline, Incyte Corporation, Janssen/Johnson & Johnson, Jasper Therapeutics, Jazz Pharmaceuticals, Inc., Karyopharm Therapeutics, Kiadis Pharma, Kite, a Gilead Company, Kyowa Kirin, Magenta Therapeutics, Medac GmbH, Merck & Co., Millennium, the Takeda Oncology Co., Miltenyi Biotec, Inc., MorphoSys, Novartis Pharmaceuticals Corporation, Omeros Corporation, Oncopeptides, Inc., Orca Biosystems, Inc., Pfizer, Inc., Pharmacyclics, LLC, Sanofi Genzyme, Seagen, Inc., Stemcyte, Takeda Pharmaceuticals, Tscan, Vertex, Vor Biopharma, and Xenikos BV.
Hamadani M, Gopal AK, Pasquini M, et al. Allogeneic transplant and CAR-T therapy after autologous transplant failure in DLBCL: a noncomparative cohort analysis. Blood Adv. 2022;6(2):486-494. doi:10.1182/bloodadvances.2021005788