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ASH 2025 | A real-world analysis of CAR T-cell therapy vs autoSCT in patients with LBCL in complete remission
Rémy Duléry, MD, PhD, Saint-Antoine Hospital, Sorbonne University, Paris, France & Dana Farber Cancer Institute, Boston, MA, discusses an extensive real-world analysis comparing the outcomes of patients with large B-cell lymphoma (LBCL) undergoing autologous stem cell transplantation (autoSCT) or CAR T-cell therapy in complete remission (CR). Dr Duléry highlights that survival rates were comparable between groups and discusses the potential implications of these findings. This interview took place at the 67th ASH Annual Meeting and Exposition, held in Orlando, FL.
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Transcript
In large B-cell lymphoma, both autologous transplants and CAR T-cell therapy are efficient options for patients who achieve complete remission after salvage therapy. However, it’s unclear which approach offers the best outcomes. And recently, there was a CIBMTR study that shows higher PFS and lower relapse incidence with autologous transplants, which prompted us to address this question in a large real-world study...
In large B-cell lymphoma, both autologous transplants and CAR T-cell therapy are efficient options for patients who achieve complete remission after salvage therapy. However, it’s unclear which approach offers the best outcomes. And recently, there was a CIBMTR study that shows higher PFS and lower relapse incidence with autologous transplants, which prompted us to address this question in a large real-world study. Using the EBMT registry, we included over 2,000 patients who received autologous transplants and 349 patients who received CAR T-cell therapy, including 28 in second line. All patients were in complete remission at the time of infusion. So in the entire cohort, outcomes favor autologous transplants with higher two-year PFS and overall survival. Now, if we focus on the subgroup of patients who received axicabtagene ciloleucel, there was no difference in terms of relapse incidence and non-relapse mortality and progression-free survival. However, overall survival remained higher with autologous transplants compared to axicabtagene ciloleucel. And importantly, with a propensity score matched per multivariate analysis, we showed that there is no difference in terms of overall survival, progression-free survival, non-relapse mortality, and relapse incidence when you compare autologous transplants to CAR T-cell. So what’s the meaning of all this study? Well, in selected fit and transplant-eligible patients with large B-cell lymphoma who achieve complete remission, autologous transplants are a valid option. Actually, both autologous transplants and CAR T-cell offer favorable survival with a two-year overall survival of 80% with autologous transplants and 71% with CAR T-cell therapy. So while the priority is to expand access to CAR T-cell therapy, we believe with this data that it’s reasonable to propose autologous transplants in this selected population, very specific, who will reach complete remission.
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