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

Anna Sureda, MD, PhD, Catalan Institute of Oncology, Duran I Reynals Hospital, Barcelona, Spain, summarizes her arguments in favor of CAR-T therapy replacing autologous transplantation in patients with high-risk relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) in the next five years. Currently, patients treated with the current standard of care (SOC) have poor outcomes. The ZUMA-7 (NCT03391466) and TRANSFORM (NCT03575351) studies comparing axicabtagene ciloleucel (axi-cel) and lisocabtagene maraleucel (liso-cel) to the SOC demonstrated a significant improvement in event-free survival (EFS) for primary refractory patients treated with CAR-T therapy. According to Dr Sureda, this will lead to a decrease in the number of autologous transplants and an increase in the use of CAR-Ts over the next few years. This interview took place at the Transplantation & Cellular Therapy (TCT) Meetings of ASTCT™ and CIBMTR® 2022 in Salt Lake City, Utah.

Transcript (edited for clarity)

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...

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.

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