Comparative effectiveness of CAR-T cell therapy and BiTE therapy in relapsed/refractory diffuse large B-cell lymphoma: A propensity score matching analysis using real-world data from the US collaborative network database.

Abstract

e19020 Background: Diffuse Large B-cell lymphoma is the most common form of non-Hodgkin lymphoma. Relapsed/refractory Diffuse Large B-cell Lymphoma (DLBCL) presents significant treatment challenges. CAR-T cell therapy and BiTE therapies have emerged as promising options. This study aims to compare their effectiveness using propensity score matching, leveraging real-world data from the TriNetX network to assess clinical outcomes and guide treatment decisions for DLBCL. Methods: This retrospective cohort study utilized the TriNetX database, a global health research network, to identify adult patients with relapsed/refractory Diffuse Large B-cell Lymphoma (DLBCL) who received CAR-T cell therapy or BiTE therapy. The CAR-T cell therapy included axicabtagene, lisocabtagene, tisagenlecleucel) or BiTE therapy included Epcoritamab and Glofitamab. A propensity score matching (PSM) approach was used to balance baseline characteristics between the two treatment groups, minimizing confounding biases. Key covariates such as age, sex, comorbidities, model. 1:1 matching was performed using nearest-neighbour matching without replacement, ensuring comparability between the CAR-T and BiTE groups. Results: Before PSM, there were 1,533 patients in the CAR-T cohort and 142 patients in the BITE therapy cohort; however, after PSM, there were 133 patients in both cohorts. Mean age (59.4 vs 57.9 years), male (60.53% vs 57.04%), white (76.69% vs 72.18%). Compared to BITE therapy, CAR-T therapy demonstrated improved overall survival (OS) (hazard ratio [HR] 0.45 (95% CI 0.32-0.61, p < 0.95). BITE therapy also had a higher risk for pancytopenia (odds ratio [OR] 4.663 [2.35-9.26], p < 0.01). The risk of diarrhoea and fatigue was, however, not statistically significant. Conclusions: This study provides valuable real-world insights into the comparative effectiveness of CAR-T cell therapy and BiTE therapy for relapsed/refractory DLBCL. The results, derived from propensity score-matched cohorts, offer far-reaching help to guide the holistic management of this patient population.