Long wait times for chimeric antigen receptor T-cell (CAR-T) therapy for patients with diffuse large B-cell lymphoma (DLBCL) may lead to decreased effectiveness and increased complications, according to research published in JCO Clinical Cancer Informatics.

In the past few years, CAR-T therapy has been shown to be effective in select patients with relapsed or refractory DLBCL.

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Researchers developed a health system-level discrete event simulation model to analyze the potential influence of wait times on CAR-T therapy outcomes in patients with relapsed or refractory DLBCL. Wait times, health status, and clinical progression served as variables in the model.

The model was used to evaluate 9 scenarios with CAR-T therapy with wait times ranging from 1 to 9 months. Patients in this model were assumed to undergo chemotherapy while waiting to receive CAR-T therapy. The researchers simulated 10,000 patients receiving either CAR-T therapy or standard therapy and repeated the simulation 1000 times.

Baseline 1-year mortality with no wait time for CAR-T therapy was 34.0% in patients receiving CAR-T therapy compared with 75.1% in patients treated with chemotherapy. Increasing wait time from 1 to 9 months was found to increase predicted 1-year mortality from 36.1% to 76.3% in patients receiving CAR-T therapy.

Relative mortality rates increased between 6.2% and 124.5% for each additional month (up to 9) added to the baseline of no wait time. Mortality in patients receiving CAR-T therapy surpassed mortality in patients receiving chemotherapy when wait time exceeded 8 months.

In scenarios assessing outcomes with tisagenlecleucel CAR-T therapy and with no antylymphomic treatment during the wait, increased wait time was associated with increased mortality.

Even slight delays in CAR-T therapy administration could significantly hinder its efficacy and lead to complications. “Given the high cost of CAR-T therapy, it will be critical for clinicians and policymakers to develop wait time strategies that minimize delays in access to CAR-T therapy,” wrote the researchers.

Disclosures: Some authors have declared affiliations with the pharmaceutical industry. Please refer to the original study for a full list of disclosures.

Reference

1.     Tully S, Feng Z, Grindrod K, et al. Impact of increasing wait times on overall mortality of chimeric antigen receptor T-cell therapy in large B-cell lymphoma: a discrete event simulation model [published online October 23, 2019]. doi:10.1200/CCI.19.00086