TOPLINE

Among patients with large B-cell lymphoma who initiated first-line therapy, 30% received second-line treatment, while 13% died within 12 months of starting first-line therapy without receiving second-line therapy. Only a minority of eligible, fit patients received chimeric antigen receptor T‑cell (CAR T) therapy.

METHODOLOGY

• Researchers conducted a retrospective cohort study using electronic health records from a US database to evaluate real‑world treatment patterns and survival after first‑line therapy in patients with large B-cell lymphoma, with emphasis on CAR T uptake among potentially eligible patients.
• The primary analysis included 10,016 patients who initiated first-line therapy (median age, 69 years; 56% men).
• Subgroup analyses included 205 patients potentially eligible for second-line CAR T therapy (January 2022-April 2024) and 304 patients potentially eligible for third-line CAR T therapy (January 2018-December 2021).
• Researchers described treatment sequencing and patient characteristics, and they stratified CAR T fitness by age and Eastern Cooperative Oncology Group (ECOG) performance status. They analyzed survival and death before second‑line therapy.

TAKEAWAY

• Among patients who started first-line therapy, 30% later started second‑line therapy and 13% died within 12 months without receiving any second‑line treatment.
• Among patients who were potentially eligible and clearly fit for second-line CAR T, 25% received the therapy in the second‑line setting. Among those potentially eligible and clearly fit for third‑line CAR T, 35.7% received the therapy in the third‑line setting.
• The predictors of death before second‑line therapy included higher lactate dehydrogenase levels, ECOG ≥ 2, triple‑hit status, presence of B symptoms, activated B‑cell origin, higher initial stage, and male sex (P < .05 for all).
• The median time from discontinuation of first-line treatment to last confirmed clinical activity was 0.5 months for patients who died within 12 months without initiating second-line therapy, compared with 26.1 months for those who initiated second-line therapy.

IN PRACTICE

"[The] findings support ongoing clinical trials using novel therapies in the frontline setting and also emphasize the systemic issues that patients face in receiving curative, FDA-approved, and guideline-recommended 2L [second-line] treatment options," the authors of the study wrote.

SOURCE

The study was led by Miguel-Angel Perales, Memorial Sloan Kettering Cancer Center in New York City. It was published online on July 31 in Blood Advances.

LIMITATIONS

The cohort eligible for second-line CAR T therapy may have been undercaptured owing to incomplete 12‑month follow‑up for some patients. Patients referred outside the Flatiron network without documentation were not included. Data on comorbidities, distance to CAR T clinics, cause‑specific mortality, and drug toxicities were not available.

DISCLOSURES

The study was supported by Kite Pharma, a Gilead Company. Multiple authors reported being employees of Kite Pharma. Several authors reported receiving consulting fees, honoraria, research support, or advisory roles, and/or having stock ownership in multiple pharmaceutical and biotechnology companies, including Kite/Gilead, Novartis, Bristol Myers Squibb, and others. Detailed author disclosures are reported in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.