Five-year follow-up of standard-of-care axicabtagene ciloleucel for large B-cell lymphom

A report from the US Lymphoma CAR T Consortium published five-year outcomes with standard-of-care axicabtagene ciloleucel (axi-cel; autologous CD19 CAR T-cell therapy) for patients with large B-cell lymphoma (LBCL) after 2 previous lines of therapy. At five years, the progression-free survival rate was 29%, the overall survival rate was 40%, and the lymphoma-specific survival rate was 53%. However, the 5-year nonrelapse mortality (NRM) was 16.2%, with over half of NRM events occurring beyond two years. Patients who were 60 years of age or older had a lower risk of relapse (p=0.02) but a higher risk of NRM compared with younger patients (NRM odds ratio 4.5; p<0.001). Late NRM was mainly due to infections and subsequent malignant neoplasms (SMNs). The authors conclude that in the standard-of care setting, axi-cel exhibits outcomes consistent with those reported from clinical trials, with durable responses at the 5-year time point. However, late infections and development of SMNs are key survivorship issues that reduce long-term survival after CAR T-cell therapy, particularly in the elderly.