Abstract 27P
Background
In non-Hodgkin lymphoma (N-HL), relapse/refractoriness after one or more lines of therapy is still common despite the successes of current standard of care (SOC) such as rituximab. Chimeric antigen receptor (CAR) T-cell therapies could be beneficial according to studies from haematological cancers with promising response and survival results. However, several adverse events (AE) could occur after CAR T-cell treatment such as cytokine release syndrome (CRS). Our aim was to analyse the current comparative literature between CAR T-cell and SOC therapies by response, survival and AE in N-HL with a systematic review and meta-analysis.
Methods
Literature search was conducted in Embase, Medline, and Central databases on 02nd February 2024. During the selection we included articles with comparable cohorts of CAR T-cell and control patients, then extracted the odds ratios (OR) and hazard ratios (HR) of response and survival outcomes respectively with a 95% confidence interval (CI). Efficacy outcomes were distributed according to follow-up (ITT or mITT) and statistical perspective. Safety OR was calculated from the number of patients with AE.
Results
Of 29915 hits, 21 N-HL studies were included. Efficacy outcomes were tending to favour CAR T-cell vs SOC. The ITT adjusted complete- and overall response rate was OR: 2.63 (CI: 1.37-5.05) and 2.94 (CI: 1.42-6.10) respectively, mITT analyses supported these results. ITT adjusted overall survival was HR: 0.61 (CI: 0.44-0.83), like mITT. ITT adjusted progression-free survival was HR: 0.54 (CI: 0.43-0.66), however, mITT results could not show significance: mITT adjusted HR: 0.65 (CI: 0.32-1.32). Most of the AEs were not significantly different in the cohorts. Grade 3-4 febrile neutropenia, hypomagnesaemia, vomiting; grade 1-4 hypokalaemia, hypomagnesaemia, thrombocytopenia, vomiting significantly decreased during CAR T-cell treatment compared to SOC. In addition, dizziness, and hypotension significantly increased with CAR T-cell.
Conclusions
CAR T-cell in N-HL could strongly improve response and survival outcomes compared to SOC. Despite the risk of CRS, CAR T-cell is as safe as SOC, with benefit in some important serious AEs.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
Disclosure
All authors have declared no conflicts of interest.