Autologous stem-cell transplantation (ASCT) has been found to be more effective than CAR T-cell therapy in improving outcomes for patients with relapsed large B-cell lymphoma (LBCL) in complete remission, according to a retrospective analysis. The study, presented at the American Society of Hematology (ASH) meeting, showed that patients who underwent ASCT had lower rates of relapse at 2 years and better progression-free survival (PFS) and overall survival (OS) compared to those who received CAR T-cell therapy.
The analysis, based on data from the Center for International Blood & Marrow Transplant Research registry, included adults with diffuse LBCL in complete remission who were treated with CAR T-cell therapy or ASCT. The results showed that ASCT was associated with a lower relapse rate at 2 years and better PFS and OS compared to CAR T-cell therapy. In the subgroup of patients with early treatment failure, ASCT also had a lower 2-year relapse rate.
The findings of this study have important implications for clinical practice. Currently, salvage therapy with autotransplant is the standard of care for patients who relapse after first-line therapy after 12 months. This study confirms the efficacy of ASCT in these patients and suggests that it could be a reasonable option for those who achieve a good clinical response. However, the study does not support the use of CAR T-cell therapy in patients who are in complete remission.
The decision of whether to use ASCT or CAR T-cell therapy in relapsed LBCL depends on several factors. For patients in complete remission after initial relapse, ASCT may be a more appropriate choice, as these patients have already shown a good response to chemotherapy. On the other hand, CAR T-cell therapy is the treatment of choice for patients with primary refractory disease. It is important to consider the individual patient’s response to previous therapy and the potential risks and benefits of each treatment option.
There have been safety concerns regarding CAR T-cell therapy, particularly regarding the potential risk of secondary malignancies. The FDA has recently issued a safety communication regarding this issue. However, the number of secondary cancers directly related to CAR T-cell therapy is extremely low compared to the benefits it provides in curing a high percentage of patients. The safety concerns should be followed and addressed, but they should not change the practice of offering curative therapy for relapsed lymphoma.
Limitations of the Study
The retrospective nature of the analysis and the lack of randomization are important limitations to consider. This study cannot eliminate potential confounders, and a randomized trial is needed to compare the effectiveness of CAR T-cell therapy and ASCT in patients with LBCL in complete remission. Additionally, the use of tisagenlecleucel (Kymriah) in a majority of patients may have underestimated the efficacy of CAR T-cell therapy.
ASCT has been shown to be more effective than CAR T-cell therapy for patients with relapsed LBCL in complete remission. This study provides valuable insights into the optimal treatment strategy for these patients. ASCT should be considered as a reasonable option for patients who achieve a good clinical response, while CAR T-cell therapy remains the treatment of choice for primary refractory disease. Further research and randomized trials are needed to confirm these findings and optimize treatment outcomes for patients with relapsed LBCL.