Efficacy of chimeric antigen receptor T cell therapy and autologous stem cell transplant in relapsed or refractory diffuse large B-cell lymphoma: A systematic review

• Published in: Frontiers in immunology 2023-01, Vol.13, p.1041177-1041177
• Main Authors: Tian, Linyan, Li, Cheng, Sun, Juan, Zhai, Yixin, Wang, Jinhuan, Liu, Su, Jiang, Yanan, Wu, Wenqi, Xing, Donghui, Lv, Yangyang, Guo, Jing, Xu, Hong, Sun, Huimeng, Li, Yuhang, Li, Lanfang, Zhao, Zhigang
• Format: Article
• Language: English
• Subjects: auto-HSCT; CAR-T cell; Hematopoietic Stem Cell Transplantation; Humans; Immunology; Lymphoma, Large B-Cell, Diffuse - therapy; Lymphoma, Non-Hodgkin; meta-analysis; R/R DLBCL; Receptors, Chimeric Antigen - genetics; Stem Cell Transplantation; survival; Transplantation, Autologous
• ISSN: 1664-3224; 1664-3224
• DOI: 10.3389/fimmu.2022.1041177

We aimed to compare the efficacy of chimeric antigen receptor T (CAR-T) cell therapy with that of autologous stem cell transplantation (auto-HSCT) in relapsed/refractory diffuse large B cell lymphoma (R/R DLBCL). We searched eligible publications up to January 31st, 2022, in PubMed, Cochrane Library, Springer, and Scopus. A total of 16 publications with 3484 patients were independently evaluated and analyzed using STATA SE software. Patients who underwent CAR-T cell therapy showed a better overall response rate (ORR) and partial response (PR) than those treated with auto-HSCT (CAR-T vs. auto-HSCT, ORR: 80% vs. 73%, HR:0.90,95%CI:0.76-1.07, = 0.001; PR: 20% vs. 14%, HR:0.65,95%CI:0.62-0.68, = 0.034). No significant difference was observed in 6-month overall survival (OS) (CAR-T vs. auto-HSCT, six-month OS: 81% vs. 84%, HR:1.23,95%CI:0.63-2.38, = 0.299), while auto-HSCT showed a favorable 1 and 2-year OS (CAR-T vs. auto-HSCT, one-year OS: 64% vs. 73%, HR:2.42,95%CI:2.27-2.79, P < 0.001; two-year OS: 54% vs. 68%, HR:1.81,95%CI:1.78-1.97, P < 0.001). Auto-HSCT also had advantages in progression-free survival (PFS) (CAR-T vs. auto-HSCT, six-month PFS: 53% vs. 76%, HR:2.81,95%CI:2.53-3.11, < 0.001; one-year PFS: 46% vs. 61%, HR:1.84,95%CI:1.72-1.97, < 0.001; two-year PFS: 42% vs. 54%, HR:1.62,95%CI:1.53-1.71, < 0.001). Subgroup analysis by age, prior lines of therapy, and ECOG scores was performed to compare the efficacy of both treatment modalities. Although CAR-T cell therapy showed a beneficial ORR, auto-HSCT exhibited a better long-term treatment superiority in R/R DLBCL patients. Survival outcomes were consistent across different subgroups.