The ZUMA-7 trial demonstrated the superiority of second-line CAR-T cell therapy over standard of care chemotherapy +/- autotransplant for relapsed/refractory (r/r) large B-cell lymphoma (LBCL). We conducted a retrospective, population-based analysis to determine eligibility for second-line CAR-T cell therapy in the real-world setting. Among 125 patients with r/r LBCL between 2015-2019, 82% progressed within 12 months of first-line chemoimmunotherapy (CIT), 40% were treated with intention-to-transplant, 22% underwent autotransplant, and 7% achieved a durable remission after autotransplant. With median follow-up time 2.8 years, median OS was 5.1 months and 3-year OS was 15% (95% CI 7-20%) for all patients and 10% (95% CI 5-17%) for those progressing within 12 months of CIT. Although only 14% of patients fulfilled all ZUMA-7 study inclusion criteria, as many as 65% of patients progressing within 12 months of CIT had adequate performance status to be considered potentially eligible for second-line CAR-T cell therapy. Whereas the current standard of care results in poor outcomes for most patients with r/r LBCL, the use of CAR-T cell therapy in second line could substantially increase the proportion of patients able to receive curative-intent treatment at first progression of LBCL.
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