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CAR T in patients with large B-cell lymphoma not fit for autologous transplant

Lookup NU author(s): Dr Tobias Menne, Dr Wendy Osborne


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© 2023 British Society for Haematology and John Wiley & Sons Ltd.Large B-cell lymphoma (LBCL) patients with comorbidities and/or advanced age are increasingly considered for treatment with CD19 CAR T, but data on the clinical benefit of CAR T in the less fit patient population are still limited. We analysed outcomes of consecutive patients approved for treatment with axicabtagene ciloleucel (axi-cel) or tisagenlecleucel (tisa-cel) by the UK National CAR T Clinical Panel, according to fitness for autologous stem cell transplant (ASCT). 81/404 (20%) of approved patients were deemed unfit for ASCT. Unfit patients were more likely to receive tisa-cel versus axi-cel (52% vs. 48%) compared to 20% versus 80% in ASCT-fit patients; p < 0.0001. The drop-out rate from approval to infusion was significantly higher in the ASCT-unfit group (34.6% vs. 23.5%; p = 0.042). Among infused patients, response rate, progression-free and overall survival were similar in both cohorts. CAR T was well-tolerated in ASCT-unfit patients with an incidence of grade ≥3 cytokine release syndrome and neurotoxicity of 2% and 11%, respectively. Results from this multicentre real-world cohort demonstrate that CD19 CAR T can be safely delivered in carefully selected older patients and patients with comorbidities who are not deemed suitable for transplant.

Publication metadata

Author(s): Kuhnl A, Kirkwood AA, Roddie C, Menne T, Tholouli E, Bloor A, Besley C, Chaganti S, Osborne W, Norman J, Gibb A, Sharplin K, Cuadrado M, CorreiadeFarias M, Cheok K, Neill L, Latif AL, GonzalezArias C, Uttenthal B, Jones C, Johnson R, McMillan A, Sanderson R, Townsend W

Publication type: Article

Publication status: Published

Journal: British Journal of Haematology

Year: 2023

Volume: 202

Issue: 1

Pages: 65-73

Print publication date: 01/07/2023

Online publication date: 20/04/2023

Acceptance date: 31/03/2023

ISSN (print): 0007-1048

ISSN (electronic): 1365-2141

Publisher: John Wiley and Sons Inc


DOI: 10.1111/bjh.18810

PubMed id: 37082780


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