The 2022 Tandem Meetings | CAR-T therapy vs autologous transplantation in R/R DLBCL

Well, it was a kind of double debate because the first two speakers they were talking about CAR-T yes or no in front of autologous transplant in patients with multiple myeloma. And I participated in the second debate that was related to relapsed/refractory diffuse large B-cell lymphoma. And basically I was defending the yes position indicating that probably in the next five years, CAR-Ts are going to take over autologous stem cell transplantation in a subgroup of patients with high risk relapsed/refractory diffuse large B-cell lymphoma.

So basically in summary, these patients have quite a poor outcome with the use of the standard of care. And the standard of care is salvage chemotherapy and consolidation with autologous stem cell transplant in those patients that achieve a complete remission or a partial remission. The long-term outcome of this patient we thought to transplant is quite poor with a progression-free survival which is around 20 or 25% being a little bit optimistic.

And now we have three prospective clinical trials. Two of them that have given positive results in terms of CAR T giving a better event-free survival which was the primary endpoint in front of the standard of care in patients with primary refractory and early-relapse, basically patients relapsing in the first one year after the end of first line conventional chemoimmunotherapy treatment. So on the basis of these positive results that were seen in ZUMA-7 which compares axi-cel with auto-transplant and the TRANSFORM trial that compares liso-cell with autologous transplantation. Most probably in the next few years, the numbers of autologous stem cell transplantation are going to decrease in the same way that CAR-Ts are going to increase in this population of patients.