A real-world comparison of commercial-use axicabtagene ciloleucel and lisocabtagene maraleucel in large B-cell lymphoma
In a real-world retrospective study published in Blood Advances, researchers at the Dana-Farber Cancer Institute compared the commercial use of two anti-CD19 CAR T-cell therapies, axicabtagene ciloleucel (axi-cel) and lisocabtagene maraleucel (liso-cel), in patients with relapsed/refractory large B-cell lymphoma (LBCL). The study included 87 patients treated in the third-line setting, with 50 receiving axi-cel and 37 receiving liso-cel.
While overall response rates were comparable (72% for axi-cel vs. 62% for liso-cel), and median progression-free survival (PFS) at 12 months was 59% and 44%, respectively, a propensity score analysis adjusting for differences in patient risk factors revealed inferior PFS with liso-cel (hazard ratio 2.95, 95% CI 1.14-7.60). This suggests that axi-cel may provide a more durable response in higher-risk patients. Significant differences were observed in treatment logistics and toxicity. The median time from leukapheresis to infusion was longer for liso-cel (41 vs. 30 days). Axi-cel recipients had higher rates of cytokine release syndrome (CRS; 90% vs. 54%) and immune effector cell-associated neurotoxicity syndrome (ICANS; 52% vs. 27%), though severe cases (grade ≥3) were similar between groups. Prolonged neutropenia at day 30 or later was more frequent in axi-cel recipients (24% vs. 0%).
The longer wait time for liso-cel may have led to selection bias, as these patients were generally older (median age 73 vs. 62 years). Despite these differences, both therapies demonstrated efficacy similar to clinical trial results. Overall, this study demonstrates the importance of individualized CAR T-cell therapy selection, considering factors such as disease risk, toxicity profiles, and manufacturing timelines. The authors recommend further multicenter evaluations to confirm these findings and guide optimal therapy choice.
Reference
Looka A, Qualls DA, Matthews D, et al. A real-world comparison of commercial use axicabtagene ciloleucel and lisocabtagene maraleucel in large B-cell lymphoma. Blood Adv. Published online November 15, 2024.