Allogeneic HSCT Still a 'Curative Option' After CAR-T in LBCL

Allogeneic hematopoietic stem cell transplantation (HSCT) “remains a curative option” for certain patients with large B-cell lymphoma (LBCL) who relapse after chimeric antigen receptor (CAR) T-cell therapy, according to research presented at the 64th American Society of Hematology Annual Meeting and Exposition.

The researchers conducted a retrospective study including all patients who underwent allogeneic HSCT or received CAR T-cell therapy at a single center in France between February 2010 and January 2022. They analyzed data from 95 patients with relapsed/refractory LBCL, 35 of whom underwent allogeneic HSCT and 56 of whom received CAR-T therapy. Patients who underwent transplant had a median of three prior lines of therapy, while those receiving CAR-T had a median of two prior lines of therapy.

The median patient age was 56 years old in patients undergoing transplant, while it was 58 years old in patients receiving CAR-T therapy. A significantly greater proportion of patients receiving CAR-T therapy had primary refractory disease (71.4%) than those who underwent allogeneic HSCT (38.4%).

The two-year overall survival rate was 69% in patients who underwent allogeneic HSCT, while it was 67% for those receiving CAR-T. The two-year progression-free survival rate was 66% in patients who underwent allogeneic HSCT, while it was 43% for those receiving CAR-T.

At a median follow-up of 23.2 months, half of the patients receiving CAR-T had disease progression/relapse, with five patients undergoing allogeneic HSCT after CAR-T failure. Of those five patients, one had a partial response at the time of conditioning and four others had complete response. At a median follow-up of 14 months, four of those patients were still in response, with one having an early relapse.

“Our results confirm efficacy and safety of CAR-T in [relapsed/refractory] LBCL, with durable complete responses in about 40% of patients in the third-line setting,” the study’s authors concluded. “However, early failures after infusion require prompt diagnosis and management because they portend a very dismal prognosis. In this context, our data show that [allogeneic HSCT] remains a curative option for selected LBCL patients relapsing after CAR T-cell therapy with manageable toxicity.”

Reference

Roché P, Brisou G, Furst S, et al. Allogeneic transplant as a curative option for relapsed/refractory large B-cell lymphoma in the era of CAR T-cell therapy: a monocentric retrospective study. Abstract #3445. Presented at the 64th ASH Annual Meeting and Exposition; December 10-13, 2022; New Orleans, Louisiana.