Axicabtagene ciloleucel compared to tisagenlecleucel for the treatment of aggressive B-cell lymphoma

Abstract

Axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel) are CD19-targeted chimeric antigen receptor (CAR) T-cells approved for relapsed/refractory (R/R) large B-cell lymphoma (LBCL). We performed a retrospective study to evaluate safety and efficacy of axi-cel and tisa-cel outside the setting of a clinical trial. Data from consecutive patients with R/R LBCL who underwent apheresis for axi-cel or tisa-cel were retrospectively collected from 12 Spanish centers. A total of 307 patients underwent apheresis for axi-cel (n=152) and tisa-cel (n=155) from Nov-2018 to Aug-2021, of which 261 (85%) received a CAR-T infusion (88% and 82%, respectively). Median time from apheresis to infusion was 41 days for axi-cel and 52 days for tisa-cel (p=0.006). None of the baseline characteristics were significantly different between both cohorts. Both cytokine release syndrome and neurologic events (NE) were more frequent in the axi-cel group (88% vs 73%, p=0.003, and 42% vs 16%, p

Impact of age on outcome of CAR-T cell therapies for large B-cell lymphoma: the GLA/DRST experience

“…Indeed, although we did not assess the time between start of 1 st -line therapy and first relapse/progression, the shorter interval between diagnosis and dosing in the younger cohort suggests a larger fraction of patients with primary/early treatment failure, despite more aggressive induction and also salvage therapy (Supplementary Table S2). Thus, the reason for the difference between the age groups observed here might be that our younger patients obviously represent an extraordinarily unfavorable selection [11], while the outcome of the elderly is comparable to other published realworld experience [4][5][6].…”

“…There have been a few studies suggesting that advanced age is not a major obstacle for CD19-directed CAR-T therapy in r/r LBCL [2][3][4][5], including the recent large post-authorization safety study conducted by the CIBMTR for axi-cel [6]. In the latter, ORR and PFS tended to be better in 484 patients aged 65 or higher compared to 813 younger patients on multivariate analysis, despite significantly higher risks of overall and grade ≥3 CRS and neurotoxocity, respectively, in the elderly [6].…”

The place of allogeneic stem cell transplantation in aggressive B-cell non-Hodgkin lymphoma in the era of CAR-T-cell therapy

“…In a second study, 307 patients were analyzed (152 who received axi-cel vs. 155 who received tisa-cel) in a multicentre setting. The patient characteristics were well balanced, and while the ORR, duration of response (DOR), PFS and OS were not significantly different between the treatments, the incidence of ICANS was higher while the CRS rate was similar after axi-cel ( 32 ). Different findings were reported in the second study ( 33 ), in which a large number of patients included in the DESCART national registry were analyzed (209 who received tisa-cell vs. 209 who received axi-cel) using propensity score matching to reduce differences in variables associated with outcomes.…”

CAR T‐cell therapy in large B cell lymphoma

“…Second generation CD19‐CAR T‐cells bearing a crucial costimulatory molecule first demonstrated pre‐clinical efficacy in hematologic malignancies in 2003 1 . Since then, several of these products have led to impressive response rates and durable remissions in the treatment of relapsed or refractory aggressive non‐Hodgkin lymphoma (NHL), including large B cell lymphoma (LBCL) 2–18 . Axicabtagene ciloleucel (axi‐cel; KTE‐C19) is an autologous CD19‐CAR T‐cell product bearing a CD28 costimulatory domain.…”