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

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 FuDavid Muramoto, Hairong Xu, Marcelo C. Pasquini

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)880-889
Number of pages10
JournalAmerican Journal of Hematology
Volume99
Issue number5
DOIs
StatePublished - May 2024

ASJC Scopus subject areas

  • Hematology

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