For patients with large B-cell lymphoma (LBCL) who have an early relapse or whose cancer doesn’t respond to first-line treatment, randomized trials have shown that chimeric antigen receptor (CAR) T-cell therapy is superior to the historical standard of care, which included additional chemotherapy followed by high-dose chemotherapy plus a transplant of the patient’s own stem cells. However, due to the high demand for CAR T-cell therapy, patients often face long waits to receive it and need additional chemotherapy as a “bridge” to the treatment. For some of these patients, that bridging chemotherapy may bring about a complete remission.
A new study presented at the 2023 ASH Annual Meeting & Exposition based on data from the Center for International Blood & Marrow Transplant Research registry of patients treated with stem cell transplants, CAR T-cell therapy, and similar treatments found that when patients in complete remission received high-dose chemotherapy plus an autologous stem cell transplant (ASCT), they had fewer second relapses and their cancer stayed in remission for longer, compared with similar patients who received CAR T-cell therapy (Abstract 781). At 2 years after treatment, 27.8% of patients treated with ASCT experienced another relapse, compared with 48% of those treated with CAR T-cell therapy.
Study Background
Around 60% of patients with newly diagnosed diffuse LBCL respond well to chemotherapy and don’t need further treatment, said Mazyar Shadman, MD, MPH, Associate Professor at Fred Hutchinson Cancer Center and the University of Washington and the study’s lead author. For patients whose disease either does not respond to initial chemotherapy or recurs within 12 months, high-dose chemotherapy plus ASCT has historically been the standard of care. Now, however, these patients are eligible to receive CAR T-cell therapy.
Mazyar Shadman, MD, MPH
“Our findings support high-dose chemotherapy plus ASCT as a valid treatment option in real-world practice for patients who achieve a complete remission and also for the subset of patients who have relapsed and may be candidates for CAR T-cell therapy, but achieve a complete remission with bridging chemotherapy,” said Dr. Shadman. “ASCT also remains the treatment choice in patients with late relapse who achieve a complete remission, as there is not data to suggest that CAR [T-cell therapy] is more efficacious.”
The results are consistent with a previous finding by Dr. Shadman and his colleagues that relapsed patients who achieved partial remission had improved outcomes with ASCT compared with CAR T-cell therapy.
“If they relapse again after ASCT, they still have the option of undergoing CAR T-cell therapy—but it’s more difficult to do high-dose chemotherapy plus ASCT if they relapse after CAR T-cell therapy,” he said.
Research Details
Dr. Shadman and his colleagues analyzed data from the Center for International Blood & Marrow Transplantation Research (CIBMTR) database to compare outcomes for patients with relapsed LBCL who were treated with either ASCT or CAR T-cell therapy. The CIBMTR database includes clinical information for more than 630,000 patients worldwide who have been treated with autologous or donor stem cell transplants, CAR T-cell therapies, and other cellular therapies, including most of those treated in the United States.
In 2022, Dr. Shadman and his team reported in the journal Blood their findings for 411 adult patients with relapsed LBCL who received either CAR T-cell therapy or ASCT while in partial remission. They found that patients who received ASCT had fewer relapses and lived longer than those treated with CAR T-cell therapy.
Current Results
For the current study, the researchers compared outcomes for 360 adult patients (average age = approximately 62) years with relapsed LBCL who received either CAR T-cell therapy or ASCT while in complete remission. The study’s primary endpoints were progression-free and overall survival. Results showed that patients in the ASCT group had longer remissions and lived longer than those in the CAR T-cell therapy group (progression-free survival = 66.2%, overall survival = 78.9% for the ASCT group vs progression-free survival = 47.8%, overall survival; = 65.6% for the CAR T-cell therapy group).
A limitation of the study is that it is based on a look back at outcomes for patients treated in the past, rather than a clinical trial in which patients were assigned at random to receive ASCT or CAR T-cell therapy, Dr. Shadman said.
Disclosure: For full disclosures of the study authors, visit ash.confex.com.
