Overview
While chimeric antigen receptor T-cell (CAR T) therapy has advanced care for relapsed or refractory large B-cell lymphoma (LBCL), over half of patients eventually experience disease relapse. This real-world study evaluated demographics, treatment patterns, and outcomes among 815 patients in the US Flatiron Health Research Database with LBCL who initiated a subsequent line of therapy following CAR T failure.
The most common post-CAR T treatment classes were chemoimmunotherapy (26.6%) and bispecific antibodies (20.1%). Treatment patterns reflected an era shift: chemoimmunotherapy was predominant in earlier years (35.1%), whereas bispecific antibodies became the most common salvage choice in the modern era across both second-line (39.3%) and third-line or later (30.5%) settings. Overall median real-world progression-free survival was 3.8 months and median real-world overall survival was 9.8 months. Outcomes varied by relapse timing, with late relapses (>6 months post-CAR T) exhibiting longer real-world overall survival (21.4 months) compared to primary refractory disease (6.8 months) or early relapses (11.3 months).
Why this matters
This study illustrates a real-world shift toward bispecific antibodies following CAR T failure in LBCL, while indicating that survival outcomes remain limited in this setting. The findings highlight the timing of CAR T failure as a key prognostic factor, offering valuable context for risk stratification and clinical management.