Second-Line Tisagenlecleucel or Standard Care in Aggressive B-Cell Lymphoma

Michael R. Bishop, Michael Dickinson, Duncan Purtill, Pere Barba, Armando Santoro, Nada Hamad, Koji Kato, Anna Sureda, Richard Greil, Catherine Thieblemont, Franck Morschhauser, Martin Janz, Ian Flinn, Werner Rabitsch, Yok Lam Kwong, Marie J. Kersten, Monique C. Minnema, Harald Holte, Esther H.L. Chan, Joaquin Martinez-LopezAntonia M.S. Müller, Richard T. Maziarz, Joseph P. McGuirk, Emmanuel Bachy, Steven Le Gouill, Martin Dreyling, Hideo Harigae, David Bond, Charalambos Andreadis, Peter McSweeney, Mohamed Kharfan-Dabaja, Simon Newsome, Evgeny Degtyarev, Rakesh Awasthi, Christopher Del Corral, Giovanna Andreola, Aisha Masood, Stephen J. Schuster, Ulrich Jäger, Peter Borchmann, Jason R. Westin

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

BACKGROUND: Patient outcomes are poor for aggressive B-cell non-Hodgkin's lymphomas not responding to or progressing within 12 months after first-line therapy. Tisagenlecleucel is an anti-CD19 chimeric antigen receptor T-cell therapy approved for diffuse large B-cell lymphoma after at least two treatment lines. METHODS: We conducted an international phase 3 trial involving patients with aggressive lymphoma that was refractory to or progressing within 12 months after first-line therapy. Patients were randomly assigned to receive tisagenlecleucel with optional bridging therapy (tisagenlecleucel group) or salvage chemotherapy and autologous hematopoietic stem-cell transplantation (HSCT) (standard-care group). The primary end point was event-free survival, defined as the time from randomization to stable or progressive disease at or after the week 12 assessment or death. Crossover to receive tisagenlecleucel was allowed if a defined event occurred at or after the week 12 assessment. Other end points included response and safety. RESULTS: A total of 322 patients underwent randomization. At baseline, the percentage of patients with high-grade lymphomas was higher in the tisagenlecleucel group than in the standard-care group (24.1% vs. 16.9%), as was the percentage with an International Prognostic Index score (range, 0 to 5, with higher scores indicating a worse prognosis) of 2 or higher (65.4% vs. 57.5%). A total of 95.7% of the patients in the tisagenlecleucel group received tisagenlecleucel; 32.5% of the patients in the standard-care group received autologous HSCT. The median time from leukapheresis to tisagenlecleucel infusion was 52 days. A total of 25.9% of the patients in the tisagenlecleucel group had lymphoma progression at week 6, as compared with 13.8% of those in the standard-care group. The median event-free survival in both groups was 3.0 months (hazard ratio for event or death in the tisagenlecleucel group, 1.07; 95% confidence interval, 0.82 to 1.40; P = 0.61). A response occurred in 46.3% of the patients in the tisagenlecleucel group and in 42.5% in the standardcare group. Ten patients in the tisagenlecleucel group and 13 in the standard-care group died from adverse events. CONCLUSIONS: Tisagenlecleucel was not superior to standard salvage therapy in this trial. Additional studies are needed to assess which patients may obtain the most benefit from each approach.

Original languageEnglish (US)
Pages (from-to)629-639
Number of pages11
JournalNew England Journal of Medicine
Volume386
Issue number7
DOIs
StatePublished - Feb 17 2022
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)

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