Autologous Transplant or <scp>CAR</scp>‐T as Consolidation Options in <scp>MYC</scp> Rearranged Large B‐Cell Lymphoma Patients in Remission After Salvage Treatments

Although recent studies have demonstrated the efficacy of chimeric antigen receptor T-cell (CAR-T) therapy in relapsed large B-cell lymphoma (LBCL) with MYC rearrangement (R-MYC), the data comparing CAR-T to autologous hematopoietic cell transplant (auto-HCT) in such patients who achieve a complete or partial response (CR/PR) after salvage therapies are limited. We compared the clinical outcomes of patients with R-MYC LBCL (including double and triple hit lymphomas) who underwent CAR-T or auto-HCT after achieving a CR/PR with salvage therapies using the Center for International Blood & Marrow Transplant Research registry. Among the 252 patients (auto-HCT = 98, CAR-T = 154), relative to auto-HCT, CAR-T was associated with significantly lower overall survival (OS) (Hazard Ratio [HR] 2.09, 95% CI 1.38-3.15, p < 0.001) on multivariate analysis. There were no differences in progression-free survival (PFS) (HR 1.21, 95% CI 0.81-1.8 p = 0.36), risk of relapse (HR 1.1, 95% CI 0.71-1.69 p = 0.68), nonrelapse mortality (NRM) (HR 1.74, 95% CI 0.64-4.7 p = 0.28) while the post-relapse survival was longer in auto-HCT relative to CAR-T (HR 1.93, 95% CI 1.21-3.06 p = 0.01). On propensity score matched analysis accounting for differences in characteristics across the two cohorts, we detected no significant differences in OS (HR 1.72, 95% CI 0.92-3.21 p = 0.09), PFS (HR 1.04, 95% CI 0.64-1.68 p = 0.88), NRM (HR 1.22, 95% CI 0.35-4.2 p = 0.76), relapse (HR = 0.93, 95% CI 0.54-1.6 p = 0.8) and post-relapse survival (HR 2.25, 95% CI 0.98-5.17, p = 0.06). These data, although retrospective, support consideration for auto-HCT in patients with R-MYC LBCL who achieve a CR/PR after salvage therapies, particularly in regions with no or limited access to CAR-T.

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Journal
American Journal of Hematology
Published
2025-04-15
DOI
https://doi.org/10.1002/ajh.27687
Primary Topic
CAR-T cell therapy research
Type
article
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article

Autologous Transplant or CAR‐T as Consolidation Options in MYC Rearranged Large B‐Cell Lymphoma Patients in Remission After Salvage Treatments

Kwang Woo Ahn, Allison Winter, Mehdi Hamadani, John M. McCarty et al.
American Journal of Hematology
CAR-T cell therapy research
article

Autologous Transplant or CAR‐T as Consolidation Options in MYC Rearranged Large B‐Cell Lymphoma Patients in Remission After Salvage Treatments

Kwang Woo Ahn, Allison Winter, Mehdi Hamadani, John M. McCarty, Akash Mukherjee, Alex Francisco Herrera, Craig S. Sauter, Evandro D. Bezerra, Forat Lutfi, Melody Smith, Mazyar Shadman, John H. Baird, Stephen M. Ansell, Farrukh T. Awan, Jinalben Patel, Fateeha Furqan, Jason T. Romancik, Arushi Khurana, Lazaros J. Lekakis, Stephen J. Schuster, Cameron J. Turtle, Umar Farooq, Rajneesh Nath, Manmeet Kaur, Henry C. Fung
article en

Abstract

Although recent studies have demonstrated the efficacy of chimeric antigen receptor T-cell (CAR-T) therapy in relapsed large B-cell lymphoma (LBCL) with MYC rearrangement (R-MYC), the data comparing CAR-T to autologous hematopoietic cell transplant (auto-HCT) in such patients who achieve a complete or partial response (CR/PR) after salvage therapies are limited. We compared the clinical outcomes of patients with R-MYC LBCL (including double and triple hit lymphomas) who underwent CAR-T or auto-HCT after achieving a CR/PR with salvage therapies using the Center for International Blood & Marrow Transplant Research registry. Among the 252 patients (auto-HCT = 98, CAR-T = 154), relative to auto-HCT, CAR-T was associated with significantly lower overall survival (OS) (Hazard Ratio [HR] 2.09, 95% CI 1.38-3.15, p < 0.001) on multivariate analysis. There were no differences in progression-free survival (PFS) (HR 1.21, 95% CI 0.81-1.8 p = 0.36), risk of relapse (HR 1.1, 95% CI 0.71-1.69 p = 0.68), nonrelapse mortality (NRM) (HR 1.74, 95% CI 0.64-4.7 p = 0.28) while the post-relapse survival was longer in auto-HCT relative to CAR-T (HR 1.93, 95% CI 1.21-3.06 p = 0.01). On propensity score matched analysis accounting for differences in characteristics across the two cohorts, we detected no significant differences in OS (HR 1.72, 95% CI 0.92-3.21 p = 0.09), PFS (HR 1.04, 95% CI 0.64-1.68 p = 0.88), NRM (HR 1.22, 95% CI 0.35-4.2 p = 0.76), relapse (HR = 0.93, 95% CI 0.54-1.6 p = 0.8) and post-relapse survival (HR 2.25, 95% CI 0.98-5.17, p = 0.06). These data, although retrospective, support consideration for auto-HCT in patients with R-MYC LBCL who achieve a CR/PR after salvage therapies, particularly in regions with no or limited access to CAR-T.

American Journal of HematologyVol. 100(7)
University of Iowa (US), Fox Chase Cancer Center (US), Cleveland Clinic (US), Mayo Clinic (US), Emory University (US), Virginia Commonwealth University (US), Medical College of Wisconsin (US), University of Washington Medical Center (US), The University of Kansas Cancer Center (US), City of Hope (US), University of Miami Hospital (US), Oncology Hematology Care (US), Sylvester Comprehensive Cancer Center (US), Banner MD Anderson Cancer Center, The Ohio State University (US), University of Pennsylvania (US), Temple University (US), The University of Texas Southwestern Medical Center (US), Stanford University (US)
Good health and well-being
Openalex Percentile: Top 89%
CAR-T cell therapy research
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