Outcomes and factors impacting use of axicabtagene ciloleucel in patients with relapsed or refractory large B-cell lymphoma: results from an intention-to-treat analysis

Abstract

Data on real-world outcomes of axicabtagene ciloleucel (axi-cel) therapy for relapsed/refractory large B-cell lymphoma (R/R LBCL) are limited. In this intent to treat (ITT) analysis, we reviewed records of 38 consecutive patients with R/R LBCL for whom axi-cel was intended. Twenty-seven (71%) patients received axi-cel and 11 (29%) did not. Patients in the non-axi-cel group had a higher hematopoietic cell transplantation comorbidity index (HCT-CI) (median 4 vs. 2, p = .04). Median overall survival for the ITT, axi-cel and non-axi-cel group was 10 (95% CI, 3.7 to 13), 13 (95% CI, 7.7 to N.R.) and 1 (95% CI, 0.4 to 3.7) month(s) respectively. Factors limiting axi-cel use were disease progression, sepsis, manufacturing failure and socioeconomic barrier in 6 (55%), 3 (27%), 1 (9%) and 1 (9%) patient(s) respectively. Additional strategies are needed to ensure all LBCL patients for whom chimeric antigen receptor (CAR) T-cell therapy is prescribed can receive this treatment.

Keywords:

• Axi-cel
• CAR T-cell therapy
• letter of medical necessity
• diffuse large B-cell lymphoma

Author contributions

B.T.H conceived the study, solicited contributions and edited the manuscript. A.M. collected the data, interpreted the results and wrote the manuscript. W.W. performed statistical analysis of the data. All other authors assisted in interpretation of results and contributed to editing the paper.

Disclosure statement

B.T.H received consulting fees and research funding from Kite, Pharma.

Data availability statement

The data that support the findings of this study are available from the corresponding author, upon reasonable request.