Efficacy of chimeric antigen receptor T cell therapy and autologous stem cell transplant in relapsed or refractory diffuse large B-cell lymphoma: A systematic review

Linyan Tian; Cheng Li; Juan Sun; Yixin Zhai; Jinhuan Wang; Su Liu; Yanan Jiang; Wenqi Wu; Donghui Xing; Yangyang Lv; Jing Guo; Hong Xu; Huimeng Sun; Yuhang Li; Lanfang Li; Zhigang Zhao

doi:10.3389/fimmu.2022.1041177

Efficacy of chimeric antigen receptor T cell therapy and autologous stem cell transplant in relapsed or refractory diffuse large B-cell lymphoma: A systematic review

Front Immunol. 2023 Jan 17:13:1041177. doi: 10.3389/fimmu.2022.1041177. eCollection 2022.

Authors

Linyan Tian¹, Cheng Li¹, Juan Sun², Yixin Zhai¹, Jinhuan Wang³, Su Liu¹, Yanan Jiang¹, Wenqi Wu¹, Donghui Xing¹, Yangyang Lv¹, Jing Guo¹, Hong Xu¹, Huimeng Sun¹, Yuhang Li¹, Lanfang Li⁴, Zhigang Zhao^{1

5}

Affiliations

¹ Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
² Clinical Testing Center, Chinese Academy of Medical Sciences Blood Disease Hospital, Chinese Academy of Medical Sciences Institute of Hematology, State Key Laboratory of Experimental Hematology, National Clinical Medical Center for Blood Disease, Tianjin, China.
³ Department of Oncology, Second Hospital of Tianjin Medical University, Institute of Urology, Tianjin, China.
⁴ Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, The Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China.
⁵ Department of Medical Oncology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China.

Abstract

Background: We aimed to compare the efficacy of chimeric antigen receptor T (CAR-T) cell therapy with that of autologous stem cell transplantation (auto-HSCT) in relapsed/refractory diffuse large B cell lymphoma (R/R DLBCL).

Research design and methods: We searched eligible publications up to January 31st, 2022, in PubMed, Cochrane Library, Springer, and Scopus. A total of 16 publications with 3484 patients were independently evaluated and analyzed using STATA SE software.

Results: Patients who underwent CAR-T cell therapy showed a better overall response rate (ORR) and partial response (PR) than those treated with auto-HSCT (CAR-T vs. auto-HSCT, ORR: 80% vs. 73%, HR:0.90,95%CI:0.76-1.07,P = 0.001; PR: 20% vs. 14%, HR:0.65,95%CI:0.62-0.68,P = 0.034). No significant difference was observed in 6-month overall survival (OS) (CAR-T vs. auto-HSCT, six-month OS: 81% vs. 84%, HR:1.23,95%CI:0.63-2.38, P = 0.299), while auto-HSCT showed a favorable 1 and 2-year OS (CAR-T vs. auto-HSCT, one-year OS: 64% vs. 73%, HR:2.42,95%CI:2.27-2.79, P < 0.001; two-year OS: 54% vs. 68%, HR:1.81,95%CI:1.78-1.97, P < 0.001). Auto-HSCT also had advantages in progression-free survival (PFS) (CAR-T vs. auto-HSCT, six-month PFS: 53% vs. 76%, HR:2.81,95%CI:2.53-3.11,P < 0.001; one-year PFS: 46% vs. 61%, HR:1.84,95%CI:1.72-1.97,P < 0.001; two-year PFS: 42% vs. 54%, HR:1.62,95%CI:1.53-1.71, P < 0.001). Subgroup analysis by age, prior lines of therapy, and ECOG scores was performed to compare the efficacy of both treatment modalities.

Conclusion: Although CAR-T cell therapy showed a beneficial ORR, auto-HSCT exhibited a better long-term treatment superiority in R/R DLBCL patients. Survival outcomes were consistent across different subgroups.

Keywords: CAR-T cell; R/R DLBCL; auto-HSCT; meta-analysis; survival.

Publication types

Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Hematopoietic Stem Cell Transplantation*
Humans
Lymphoma, Large B-Cell, Diffuse* / therapy
Lymphoma, Non-Hodgkin*
Receptors, Chimeric Antigen* / genetics
Stem Cell Transplantation
Transplantation, Autologous

Substances

Receptors, Chimeric Antigen

Grants and funding

This research was funded by the National Natural Science Foundation of China (81870150), the National Natural Science Foundation of China(81670102), the Natural Science Foundation of Tianjin(16JCYBJC25200) and the National Natural Science Foundation of China(81572543), Tianjin Key Medical Discipline(Specialty) Construction Project(TJYXZDXK-009A).