Earlier administration of CAR-T treatment may improve survival in LBCL

Axicabtagene ciloleucel (axi-cel) prolonged survival in large B-cell lymphoma (LBCL) compared with standard of care (SOC), and the ZUMA-7 trial also found that survival outcomes may differ in those with primary refractory versus early-relapse LBCL.

The study was presented at the 2025 Transportation and Cellular Therapy Tandem Meetings of ASTCT and CIBMTR in Honolulu, Hawaii.

Patients were randomized 1:1 to receive axi-cel (n=180) or SOC (n=179; chemotherapy followed by high-dose chemotherapy with autologous hematopoietic cell transplant for those who responded). Most patients (n=133 and 131, respectively) had primary refractory LBCL; the remaining patients (n=47 and 48, respectively) had early relapse LBCL.

Event-free survival (EFS; hazard ratio [HR], 0.437), progression-free survival (PFS; HR, 0.550), and overall survival (OS; HR, 0.828) improved with axi-cel in primary refractory patients and in early-relapse patients (EFS, 0.401; PFS, 0.445; HR, 0.619).

Patients with early-relapse LBCL appeared to have longer OS and PFS compared with patients with primary refractory LBCL in both the axi-cel (OS median, not reached vs 29.4 months, respectively; PFS median, not reached vs 7.2 months) and the SOC (OS, 52.0 vs 19.8 months, respectively; PFS, 6.0 vs 2.9 months) arms.

Significantly higher infiltration of CD4 and CD8 T cells (P<0.05) and lower B-cell gene expression signature representative of hypoxia, glycolytic activity, and myeloid and stromal cells were observed in patients with early relapsed compared with primary refractory LBCL.

“These findings support early referral of [patients] with relapsed and refractory LBCL for axi-cel as a preferred [second-line] SOC,” the authors concluded.

Reference

Westin JR, Oluwole OO, Kersten MJ, et al. Axicabtagene ciloleucel (axi-cel) versus standard of care (SOC) in patients with primary refractory or early relapsed large B-cell lymphoma (LBCL). Abstract #283. Presented at the Tandem Meetings | 2025 Transportation and Cellular Therapy Tandem Meetings of ASTCT and CIBMTR; February 12-15; Honolulu, Hawaii.