Comparison of CAR-T19 and autologous stem cell transplantation for refractory/relapsed non-Hodgkin’s lymphoma

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Abstract

BACKGROUND Autologous stem cell transplantation (ASCT) is the standard treatment for refractory/relapsed B cell non-Hodgkin’s lymphoma (R/R B-NHL), whereas chimeric antigen receptor T (CAR-T) therapy targeting CD19 is emerging as an alternative strategy. Here, we report a comparative analysis of the 2 strategies in a single center.METHODS We performed a prospective, single-arm study of CAR-T therapy in 29 patients with R/R B-NHL and compared the outcomes with 27 contemporaneous patients who received ASCT. NHL was diagnosed by histopathologic assessments, and the safety and efficacy of treatments were compared.RESULTS The CAR-T group exhibited better rates of complete response (CR) (48.0% vs. 20.8%, P = 0.046) and 1-year overall survival (OS) (74.4% vs. 44.5%, P = 0.044) compared with the ASCT group. Subpopulation analysis showed that patients with International Prognostic Index scores of at least 3 achieved a significantly higher objective response rate and CR rate in the CAR-T group than in the ASCT group (ORR 72.0% vs. 10.0%, P = 0.002, and CR 38.9% vs. 0%, P = 0.030, respectively). The most common severe adverse events in the CAR-T group were cytokine release syndrome, neurotoxicity, and infection compared with cytopenia, gastrointestinal toxicity, and infection in the ASCT group. Additionally, the incidence of nonhematologic severe adverse events was markedly lower in the CAR-T group than in the ASCT group (20.7% vs. 48.1%, P = 0.030).CONCLUSION CAR-T therapy exhibited superior clinical outcomes in safety and efficacy over ASCT in patients with R/R B-NHL, suggesting that CAR-T may be a recommended alternative to ASCT.TRIAL REGISTRATION ClinicalTrials.gov NCT03196830.FUNDING Funding was supplied by UniCar Therapy, National Natural Science Foundation of China (81730003), National Science and Technology Major Project (2017ZX09304021), and Science Planning Project of Suzhou (sys2018049).

Authors

Caixia Li, Ying Zhang, Changfeng Zhang, Jia Chen, Xiaoyan Lou, Xiaochen Chen, Liqing Kang, Nan Xu, Minghao Li, Jingwen Tan, Xiuli Sun, Jin Zhou, Zhen Yang, Xiangping Zong, Pu Wang, Ting Xu, Changju Qu, Haiwen Huang, Zhengming Jin, Lei Yu, Depei Wu