Second Line CD19 CAR-T vs Platinum Salvage and Autologous Stem Cell Transplant for Primary Mediastinal B-Cell Lymphoma

Primary mediastinal B-cell lymphoma (PMBCL) is a rare form of large B-cell lymphoma (LBCL) with around 90% of patients cured with frontline treatment. For relapsed or refractory (R/R) disease, the optimal treatment is unclear. CD19 chimeric antigen receptor-T cell (CAR-T) has been established as the preferred second line (2L) treatment for primary refractory or early relapsing LBCL based on the overall survival benefits observed in the landmark phase III trials. However, PMBCL patients were underrepresented on these pivotal studies. This study evaluated outcomes of 252 patients treated with 2L therapies for R/R PMBCL at 14 US institutions between 2001 and 2025. Platinum-based salvage with intent to proceed to high dose therapy and autologous stem cell transplant (HDT/ASCT) (platinum cohort) and CD19 CAR-T (CAR-T cohort) were given as 2L therapy in the real-world setting in 157 and 26 patients, respectively. Overall response rate (ORR), complete response (CR) rate and median progression-free survival (PFS) were significantly higher in the CAR-T cohort compared with the platinum cohort (ORR: 91.3% vs 44.2%, p <0.001; CR 65.2% vs 14.7%, p<0.001; median PFS not reached vs 3.5 months, hazard ratio (HR) 0.28, 95% CI 0.15-0.54, p=0.001). No significant difference was observed in overall survival. This study demonstrated superior response rate and PFS of CD19 CAR-T over platinum-based salvage with intent to proceed to HDT/ASCT as 2L treatment for R/R PMBCL.

Authors

Institutions

Publication Details

Journal
Blood Advances
Published
2026-08-20
DOI
https://doi.org/10.1182/bloodadvances.2026020965
Primary Topic
CAR-T cell therapy research
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Second Line CD19 CAR-T vs Platinum Salvage and Autologous Stem Cell Transplant for Primary Mediastinal B-Cell Lymphoma

Reem Karmali, Marcus Geer, Margaret Kelsey Baron, Yazeed Sawalha et al.
Blood Advances
CAR-T cell therapy research
article

Second Line CD19 CAR-T vs Platinum Salvage and Autologous Stem Cell Transplant for Primary Mediastinal B-Cell Lymphoma

Reem Karmali, Marcus Geer, Margaret Kelsey Baron, Yazeed Sawalha, Sree M Lanka, Sairah Ahmed, Allison Marie Bock, Yasmin H. Karimi, Stefania M. Rodriguez, Yun Kyoung Tiger, Olutobi Adewale, Adam DuVall, Joanna Meehan Rhodes, Grzegorz S. Nowakowski, Vincenzo J. Pizzuti, Krithika Shanmugasundaram, Hanan Alharthy, Peter Doukas, Joseph G. Schroers‐Martin, Xi Yang, Michael A. Spinner, Christine Argao, Christopher R. D’Angelo, Swetha Kambhampati Thiruvengadam, Brock G. Lakin, Manali Kamdar, Henry Dumke, Izel Okcu, Meryl Colton
article en

Abstract

Primary mediastinal B-cell lymphoma (PMBCL) is a rare form of large B-cell lymphoma (LBCL) with around 90% of patients cured with frontline treatment. For relapsed or refractory (R/R) disease, the optimal treatment is unclear. CD19 chimeric antigen receptor-T cell (CAR-T) has been established as the preferred second line (2L) treatment for primary refractory or early relapsing LBCL based on the overall survival benefits observed in the landmark phase III trials. However, PMBCL patients were underrepresented on these pivotal studies. This study evaluated outcomes of 252 patients treated with 2L therapies for R/R PMBCL at 14 US institutions between 2001 and 2025. Platinum-based salvage with intent to proceed to high dose therapy and autologous stem cell transplant (HDT/ASCT) (platinum cohort) and CD19 CAR-T (CAR-T cohort) were given as 2L therapy in the real-world setting in 157 and 26 patients, respectively. Overall response rate (ORR), complete response (CR) rate and median progression-free survival (PFS) were significantly higher in the CAR-T cohort compared with the platinum cohort (ORR: 91.3% vs 44.2%, p <0.001; CR 65.2% vs 14.7%, p<0.001; median PFS not reached vs 3.5 months, hazard ratio (HR) 0.28, 95% CI 0.15-0.54, p=0.001). No significant difference was observed in overall survival. This study demonstrated superior response rate and PFS of CD19 CAR-T over platinum-based salvage with intent to proceed to HDT/ASCT as 2L treatment for R/R PMBCL.

Blood Advances
Rutgers, The State University of New Jersey (US), Northwestern University (US), City Of Hope National Medical Center (US), Mayo Clinic (US), The University of Texas MD Anderson Cancer Center (US), Palo Alto University (US), University of California, San Francisco (US), University of Utah (US), University of Michigan (US), Huntsman Cancer Institute (US), Yale University (US), University of Chicago Medical Center (US), City of Hope (US), Michigan United (US), University of Colorado Cancer Center (US), Rutgers Cancer Institute (US), University of Virginia (US), The Ohio State University (US), University of Nebraska Medical Center (US), University of Colorado Denver (US), Stanford University (US)
Openalex Percentile: Top 13%
CAR-T cell therapy research
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.