Tisagenlecleucel yields superior patient-reported health-related quality of life compared to autologous stem cell transplantation in patients with relapsed/refractory large B-cell lymphomas

Chimeric Antigen Receptor (CAR) T-cell therapy is an established treatment for relapsed or refractory large B-cell lymphoma (rr LBCL). While clinical efficacy is well documented, data on health-related quality of life (HRQoL) remain limited. This study assessed HRQoL in rr LBCL patients with long-term remission after CAR T-cell therapy versus high-dose chemotherapy with autologous stem cell transplantation (HD-ASCT). Twenty-eight consecutive rr LBCL patients in sustained remission were analyzed, with 15 receiving CAR T-cell therapy (tisagenlecleucel) and 13 undergoing HD-ASCT between 2019 and 2023. HRQoL was assessed using EQ-5D-5 L and PROMIS-29 questionnaires at 12 months and at a median of 36.8 months (range 15.7-57.2 months) post cellular therapy. Groups were compared for differences in HRQoL indices and domain scores. Median age was 63.5 (range 23-73) years. Twelve months post-treatment, CAR T-cell recipients reported significantly higher HRQoL scores than HD-ASCT patients (EQ-5D-5 L index value: 0.89 ± 0.11 vs. 0.72 ± 0.21; p = 0.015). Consistently, PROMIS-29 revealed clinically meaningful advantages in the CAR T-cell cohort across all seven categories. At later follow-up, EQ-5D-5 L index values converged (index-value 0.82 ± 0.22 vs. 0.7 ± 0.25; p = 0.2), whereas PROMIS-29 still indicated sustained benefit in five domains among CAR T-cell recipients. CAR T-cell therapy was associated with superior HRQoL in the first year compared to HD-ASCT. Although some differences diminished over time, CAR T-cell patients continued to experience better outcomes in several domains. These findings highlight clinical relevance of patient-reported outcome in rr LBCL, particularly in longitudinal surveys, and underscore the value of integrating patient-centered metrics into therapeutic decisions-making.