Patterns of Survival in Patients with Aggressive B-Cell Lymphoma Treated with CD19-Directed Chimeric Antigen Receptor T-Cell Therapy (CART) As Second Versus Later Line of Therapy

• Published in: Blood 2024-11, Vol.144 (Supplement 1), p.612-612
• Main Authors: Ellsworth, Brandon L, Melody, Megan, Epperla, Narendranath, Grover, Natalie, Romancik, Jason T, Cortese, Matthew J, Bhansali, Rahul S, Moyo, Tamara K, Kenkre, Vaishalee P, Ollila, Thomas, Hess, Brian, Fitzgerald, Lindsey, Shouse, Geoffrey, Matasar, Matthew, Annunzio, Kaitlin, Herr, Megan M, Davis, James A, Jesme, Christy, Pelcovits, Ari, Moreira, Jonathan, Lin, Adam Yuh, Ma, Shuo, Winter, Jane N, Danilov, Alexey V., Shah, Nirav N., Barta, Stefan K., Cohen, Jonathon B, Gordon, Leo I., Stephens, Deborah M., Karmali, Reem
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2024-202665

Introduction Chimeric antigen receptor T-cell therapy (CART) leads to similar response rates in trials evaluating treatment as 2nd (2L) vs 3rd line (3L) and beyond in patients (pts) with relapsed/refractory (R/R) aggressive B-cell non-Hodgkin lymphoma (ZUMA-7 and TRANSFORM for 2L vs ZUMA-1 and TRANSCEND for 3L and beyond). Whether earlier vs later use of CART improves survival has not been established. We performed a multicenter retrospective analysis evaluating survival outcomes with CART according to line of therapy, specifically 2L vs 3L vs 4th line and beyond (4L+) to inform better practice. Methods Adult pts with R/R de novo diffuse large B-cell lymphoma (DLBCL) or transformed follicular lymphoma (tFL) treated with CD19-directed CART from 2015-2024 across 13 US centers were identified. Baseline characteristics compared between cohorts included: age, sex, histology, IPI, ECOG, LDH at CART collection, double hit (DHL) and double expressor status (DEL), prior autologous stem cell transplant (autoHCT), lines of therapy pre-CART, bridging therapy (BT), receipt of CART < 12 months from diagnosis, primary refractory disease (PRD) defined as refractory or relapse < 12 mo from frontline therapy, CART on clinical trial, CART construct, and toxicity. Median progression free (mPFS) and overall survival (mOS) were estimated via Kaplan-Meier. Cox regression was used to assess impact of clinical variables on survival. A p-value