ASH 2024 | Comparing real-world outcomes and toxicities with commercial axi-cel and tisa-cel for R/R FL

There are currently three anti-CD19 autologous CAR T-cell products approved by the FDA for the treatment of patients with relapsed refractory follicular lymphoma in third line or beyond – axi-cel, tisa-cel, and liso-cel. Liso-cel has been approved by the FDA very recently, so we really don’t have all the real-world data for the first two. The main difference from my biological perspective is that axi-cel is a CD28 CAR-T product, so typically associated with higher rates of CRS or cytokine release syndrome, and ICANS or immune cell associated neurotoxicity syndrome, whereas tisa-cel is a 4-1BB CAR T-cell product, typically associated with lower toxicity. So we decided to perform this multi-center, real-world experience. Multiple sites across the US participated, trying to assess whether there’s any difference after, of course, proper matching for baseline characteristics, in terms of efficacy and safety for these two products. 

What we saw is, again, after adjusting for significant differences in baseline characteristics, the overall efficacy measured as either a chance of achieving a complete remission at day 30 or day 100 or progression-free survival in follicular lymphoma was quite similar between axi-cel and tisa-cel, but as expected, even after matching, axi-cel was a more toxic product. So based on these findings, still the current practice in the follicular lymphoma community is to select Yescarta (axi-cel) for the rare, young, and fit patients and reserve instead tisa-cel for the most commonly observed older and frail patient with follicular lymphoma. Again as a reminder, follicular lymphoma, differently from large-cell lymphoma, is a disease of the elderly and these patients may have comorbid health conditions, the major part is the use of CD28 CAR T-cell products such as axi-cel. The study overall, despite being multi-centered, is still small, so we hope to generate larger data sets in the near future.

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