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ASH 2025 | Evaluating the impact of the number of bridging therapy lines on outcomes after axi-cel in LBCL
Rémy Duléry, MD, PhD, Saint-Antoine Hospital, Sorbonne University, Paris, France & Dana Farber Cancer Institute, Boston, MA, discusses a study using data from the French DESCAR-T registry (NCT04328298), which evaluated the impact of the number of bridging therapy lines on outcomes after axicabtagene ciloleucel (axi-cel) CAR T-cell therapy in relapsed/refractory (R/R) large B-cell lymphoma (LBCL). Dr Duléry notes that administering additional bridging therapy lines beyond the first bridging therapy did not benefit the majority of patients, and that there was an increased incidence of hematotoxicity without an improvement in survival outcomes. This interview took place at the 67th ASH Annual Meeting and Exposition, held in Orlando, FL.
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Transcript
Bridging therapy is widely used to control the disease while patients with large B-cell lymphoma wait for CAR T-cell therapy. We also know that a good response to bridging therapy is associated with favorable survival outcomes. However, one question remains. Should you give more than one bridging therapy line if the patient fails to control the disease after one line of bridging therapy? So to answer this question, we conducted a large real-world study using the French DESCAR-T registry...
Bridging therapy is widely used to control the disease while patients with large B-cell lymphoma wait for CAR T-cell therapy. We also know that a good response to bridging therapy is associated with favorable survival outcomes. However, one question remains. Should you give more than one bridging therapy line if the patient fails to control the disease after one line of bridging therapy? So to answer this question, we conducted a large real-world study using the French DESCAR-T registry. We included 777 patients who had a large B-cell lymphoma. They had all received at least two prior lines of therapy, at least one line of bridging therapy, and they were all intended for axi-cel. And we compared patients who received one line of bridging therapy to those who received more than one.
So what are the main findings? So in the entire cohort, we can see that patients who received multiple bridging therapy lines have inferior overall survival and progression-free survival than those who received only one bridging therapy line. Now, among patients with progressive disease after a first bridging therapy line, giving an additional bridging therapy line only improved disease status in a minority of patients. And even if you reach a disease response with additional lines, it did not translate into favorable outcomes as seen in patients who achieve a response with only one bridging therapy line. Also, and importantly, persistent hematotoxicity was more frequent with an additional bridging therapy line. And finally, with a propensity score-weighted analysis, we show that in patients who are infused with CAR T-cells in progressive disease after one bridging therapy line, those patients have a better overall survival and progression-free survival than those who received an additional bridging therapy line because of the failure of the first bridging therapy line. So overall, delaying CAR T-cell infusion to give additional bridging therapy lines did not benefit the patient. There was no improvement in terms of survival, and it increased the risk of hematotoxicity.
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