Overview
Although second-line (2L) CAR T-cell therapy is approved for relapsed or refractory diffuse large B-cell lymphoma (R/R DLBCL), real-world uptake remains limited. This retrospective study used an LLM to extract documented discussions and reasons for non-receipt across the 2L CAR T care pathway for 577 patients in the US Flatiron Health Research Database who experienced first-line treatment failure.
While 62.7% of patients had a documented CAR T discussion, sequential drop-off occurred along the care pathway: 49.4% were referred, 39.0% underwent evaluation, 23.2% completed apheresis, and 20.6% received CAR T infusion in 2L. Among non-infused patients with a documented discussion, primary barriers to receipt included comorbidities (22.4%), patient preference (19.1%), poor performance status (17.8%), rapid disease progression (14.5%), and financial considerations (9.9%).
Why this matters
By mapping the attrition along the 2L CAR T care pathway, this AI-assisted study identifies key clinical and non-clinical barriers to treatment receipt, emphasizing the need for strategies to better meet patient needs and improve access to second-line therapies.