Improved survival and health care use with CAR-T vs historical care in relapsed/refractory large B-cell lymphoma

Anti-CD19 chimeric antigen receptor T-cell (CAR-T) immunotherapies have been funded in Canada for relapsed/refractory large B-cell lymphoma (R/R-LBCL) after 2 lines of systemic therapy since late 2019. Real-world outcome data have been limited by lack of comparison to historical care. Using propensity-weighted analysis, we compared 3-year survival, health care resource use (HRU), and hospitalization events for patients with R/R-LBCL treated with CAR-T (n = 85) vs historical controls (HCs) treated before CAR-T approval who would have been eligible based on present criteria (n = 150). CAR-T 3-year overall survival (OS) was 59% (95% confidence interval [CI], 42-72; median, not reached) vs 10% (95% CI, 5-16; median, 4.4 months) in HCs. Three-year CAR-T progression-free survival (PFS) was 48% (95% CI, 32-63]; median, 14.4 months) vs 6% (95% CI, 3-11; median, 3.6 months) in HCs. The hazard ratio (HR) for OS was 0.21 (95% CI, 0.14-0.31), and for PFS was 0.28 (95% CI, 0.2-0.39), comparing CAR-T vs HCs. Per 1000 person-days at risk, patients receiving CAR-T had fewer hospital admissions than HCs (5.32 vs 9.1), emergency visits (2.33 vs 4.81), and intensive care admissions (0.53 vs 1.25), plus lower hospitalization rates for fever (0.93 vs 1.63), infection (1.48 vs 3.08), and neutropenia (0.66 vs 1.97; all P< .001). CAR-T produced a sustained survival benefit, and, despite well-described CAR-T toxicities, HCs experienced more hospitalization events, underscoring the lack of effective salvage treatments. As one of the largest real-world comparisons of patients with R/R-LBCL receiving CAR-T vs previous standard of care, this study demonstrated its improved effectiveness and reduced HRU.