Benefit of Axicabtagene Ciloleucel Versus Chemoimmunotherapy in Older Patients and/or Patients With Poor Ecog Performance Status With Relapsed or Refractory Large B-cell Lymphoma After 2 or More Lines of Prior Therapy

Authors

Matthew A Lunning
Hai-Lin Wang
Zhen-Huan Hu
Frederick L Locke
Tanya Siddiqi
Caron A Jacobson
Sairah Ahmed
David B Miklos
Yi Lin
Brian T Hill
Armin Ghobadi
Sattva S Neelapu
Jason Westin
Chrisopher Dieyi
Polly Field
Harry Miao
Shilpa A Shahani
Anik Patel
Clare Spooner
Christine Fu
David Muramoto
Hairong Xu
Marcelo C Pasquini

Publication Date

5-1-2024

Journal

American Journal of Hematology

Abstract

Axicabtagene ciloleucel (axi-cel) in trials has demonstrated favorable efficacy compared with historical controls after ≥2 lines of therapy for the treatment of relapsed or refractory (R/R) large B cell lymphoma (LBCL). Herein, we compared the real-world effectiveness of axi-cel with efficacy and effectiveness of chemoimmunotherapy (CIT) in patients aged ≥65 years and patients with Eastern Cooperative Oncology Group performance status (ECOG PS) of 2. A total of 1146 patients treated with commercial axi-cel for R/R LBCL with ≥2 lines of prior therapy were included from the Center for International Blood and Marrow Transplantation Research prospective observational study, and 469 patients treated with CIT for R/R LBCL after ≥2 lines of prior therapy were included from SCHOLAR-1 (an international, multicohort, retrospective study). After propensity score matching, at a median follow-up of 24 months for patients receiving axi-cel and 60 months for patients receiving CIT, 12-month overall survival rates were 62% and 28%, respectively (hazard ratio, 0.30 [95% CI, 0.24-0.37]). Objective response rate (ORR) was 76% (complete response [CR] rate 58%) in patients receiving axi-cel versus 28% (CR rate 16%) for those receiving CIT. A 57% difference in ORR (55% difference in CR rate) favoring axi-cel over CIT was observed among patients aged ≥65 years. Increased magnitude of benefit in response rates for axi-cel versus CIT was also observed among patients with ECOG PS = 2. These findings further support the broader use of axi-cel in older patients and patients with ECOG PS = 2 with R/R LBCL.

Keywords

Humans, Aged, Retrospective Studies, Lymphoma, Large B-Cell, Diffuse, Biological Products, Pathologic Complete Response, Immunotherapy, Adoptive, Antigens, CD19

Comments

This article has been corrected. See Am J Hematol. 2024 Dec 12. This article has been corrected. See Am J Hematol. 2024 May 7.

DOI

10.1002/ajh.27283

PMID

38504387

PMCID

PMC11665240

PubMedCentral® Posted Date

5-1-2025

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes