A real-world survival outcome comparison of a minority-rich population with DLBCL treated with CAR-T cell therapy vs. autologous stem cell transplant.

Abstract

e19016 Background: Chimeric Antigen Receptor (CAR)-T cell therapy has demonstrated superior efficacy compared to standard second-line treatments in relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL), as shown in the ZUMA-7 trial. However, registry data from CIBMTR suggests that autologous stem cell transplantation (ASCT) may outperform CAR-T therapy in patients achieving complete remission (CR). Importantly, these studies have largely excluded minority populations, leaving a significant gap in understanding the efficacy and safety of these therapies in this underserved demographic. Methods: We conducted a retrospective single-center analysis comparing CAR-T cell therapy (axicabtagene ciloleucel; n=58) with ASCT (n=45) in patients diagnosed with DLBCL or transformed follicular lymphoma between 2018 and 2024. This analysis assessed treatment efficacy, response rates, and complications in a real-world cohort enriched with minority patients. Results: Minority patients (Hispanics, African Americans, and other non-White groups) comprised the majority of the cohort: 62% in the CAR-T group and 82% in the ASCT group. Patients receiving CAR-T were more likely to have received ≥2 prior lines of therapy (86% vs. 64%, p=0.096) and were less likely to be in CR at baseline (1.75% vs. 28.6%, p=0.0006). Conversely, progressive disease was more prevalent in the CAR-T group at baseline (43.86% vs. 19.57%, p=0.012). Post-treatment responses were as follows: CR was observed in 46% of CAR-T patients versus 60% in the ASCT group (p=0.175); partial response (PR) in 19% vs. 11% (p=0.275); and stable disease (SD) in 25% vs. 17% (p=0.328). Treatment-related complications were similar between the groups, except for gastrointestinal toxicity, which was significantly higher in the ASCT cohort (65.2% vs. 8.77%, p<0.0001). Immediate mortality due to treatment-related complications was comparable (10% in CAR-T vs. 8.7% in ASCT, p=0.753). Conclusions: In this real-world, minority-rich cohort, CAR-T cell therapy achieved significant CR rates in patients with progressive disease and demonstrated a more favorable gastrointestinal toxicity profile compared to ASCT. Although it should be noted that baseline disease status were different in both these groups. These findings underscore the importance of inclusive studies to evaluate treatment efficacy and safety in a diverse population with baseline similarities. Results CAR-T (n=58) Auto (n= 45) P -value CR after treatment 27 (46%) 27 (60%) 0.175 PR after treatment 11 (19%) 5 (11%) 0.275 Stable disease (SD) 15 (25%) 8 (17%) 0.3285 Neutropenic fever 31 (54.39%) 36 (78.26%) 0.362464 GI complications 5 (8.77%) 30 (65.22%) 0.000002 Cardiac complications 3 (5.26%) 3 (6.52%) 1 Pulmonary 6 (10.53%) 6 (13.04%) 1 Sepsis 11 (19.30%) 6 (13.04%) 0.330789 Mortality during admission 6 (10.53%) 4 (8.70%) 0.753455