PMID- 33351108 OWN - NLM STAT- MEDLINE DCOM- 20210519 LR - 20210925 IS - 2473-9537 (Electronic) IS - 2473-9529 (Print) IS - 2473-9529 (Linking) VI - 4 IP - 24 DP - 2020 Dec 22 TI - CAR T cells or allogeneic transplantation as standard of care for advanced large B-cell lymphoma: an intent-to-treat comparison. PG - 6157-6168 LID - 10.1182/bloodadvances.2020003036 [doi] AB - CD19-directed chimeric antigen receptor (CAR) T-cell treatment has evolved as standard of care (SOC) for multiply relapsed/refractory (R/R) large B-cell lymphoma (LBCL). However, its potential benefit over allogeneic hematopoietic cell transplantation (alloHCT) remains unclear. We compared outcomes with both types of cellular immunotherapy (CI) by intention to treat (ITT). Eligble were all patients with R/R LBCL and institutional tumor board decision recommending SOC CAR T-cell treatment between July 2018 and February 2020, or alloHCT between January 2004 and February 2020. Primary end point was overall survival (OS) from indication. Altogether, 41 and 60 patients for whom CAR T cells and alloHCT were intended, respectively, were included. In both cohorts, virtually all patients had active disease at indication. CI was recommended as part of second-line therapy for 21 alloHCT patients but no CAR T-cell patients. Median OS from indication was 475 days with CAR T cells vs 285 days with alloHCT (P = .88) and 222 days for 39 patients for whom alloHCT beyond second line was recommended (P = .08). Of CAR T-cell and alloHCT patients, 73% and 65%, respectively, proceeded to CI. After CI, 12-month estimates for nonrelapse mortality, relapse incidence, progression-free survival, and OS for CAR T cells vs alloHCT were 3% vs 21% (P = .04), 59% vs 44% (P = .12), 39% vs 33% (P = .97), and 68% vs 54% (P = .32), respectively. In conclusion, CAR T-cell outcomes were not inferior to alloHCT outcomes, whether measured by ITT or from CI administration, supporting strategies preferring CAR T cells over alloHCT as first CI for multiply R/R LBCL. CI - (c) 2020 by The American Society of Hematology. FAU - Dreger, Peter AU - Dreger P AD - Department of Medicine V, University of Heidelberg, Heidelberg, Germany; and. FAU - Dietrich, Sascha AU - Dietrich S AD - Department of Medicine V, University of Heidelberg, Heidelberg, Germany; and. FAU - Schubert, Maria-Luisa AU - Schubert ML AD - Department of Medicine V, University of Heidelberg, Heidelberg, Germany; and. FAU - Selberg, Lorenz AU - Selberg L AD - Department of Medicine V, University of Heidelberg, Heidelberg, Germany; and. FAU - Bondong, Andrea AU - Bondong A AD - Department of Medicine V, University of Heidelberg, Heidelberg, Germany; and. FAU - Wegner, Mandy AU - Wegner M AD - Department of Medicine V, University of Heidelberg, Heidelberg, Germany; and. FAU - Stadtherr, Peter AU - Stadtherr P AD - Department of Medicine V, University of Heidelberg, Heidelberg, Germany; and. FAU - Kimmich, Christoph AU - Kimmich C AD - Department of Medicine V, University of Heidelberg, Heidelberg, Germany; and. FAU - Kosely, Florentina AU - Kosely F AD - Department of Medicine V, University of Heidelberg, Heidelberg, Germany; and. FAU - Schmitt, Anita AU - Schmitt A AD - Department of Medicine V, University of Heidelberg, Heidelberg, Germany; and. FAU - Pavel, Petra AU - Pavel P AD - Institute for Clinical Transfusion Medicine and Cell Therapy, Heidelberg, Germany. FAU - Liebers, Nora AU - Liebers N AD - Department of Medicine V, University of Heidelberg, Heidelberg, Germany; and. FAU - Luft, Thomas AU - Luft T AD - Department of Medicine V, University of Heidelberg, Heidelberg, Germany; and. FAU - Hegenbart, Ute AU - Hegenbart U AD - Department of Medicine V, University of Heidelberg, Heidelberg, Germany; and. FAU - Radujkovic, Aleksandar AU - Radujkovic A AD - Department of Medicine V, University of Heidelberg, Heidelberg, Germany; and. FAU - Ho, Anthony Dick AU - Ho AD AD - Department of Medicine V, University of Heidelberg, Heidelberg, Germany; and. FAU - Muller-Tidow, Carsten AU - Muller-Tidow C AD - Department of Medicine V, University of Heidelberg, Heidelberg, Germany; and. FAU - Schmitt, Michael AU - Schmitt M AD - Department of Medicine V, University of Heidelberg, Heidelberg, Germany; and. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Blood Adv JT - Blood advances JID - 101698425 RN - 0 (Antigens, CD19) SB - IM MH - Antigens, CD19 MH - Humans MH - *Neoplasm Recurrence, Local MH - *Standard of Care MH - T-Lymphocytes MH - Transplantation, Homologous PMC - PMC7756983 COIS- Conflict-of-interest disclosure: P.D. reports consultancy for AbbVie, AstraZeneca, Gilead, Janssen, Novartis, Riemser, and Roche; speakers' bureau for AbbVie, Gilead, Novartis, Riemser, and Roche; and research support from Neovii and Riemser. C.K. reports advisory board membership for Gilead. M.S. reports research grants from Apogenix, Hexal, and Novartis; travel grants from Hexal and Kite; financial support for educational activities and conferences from bluebird bio, Kite, and Novartis; and advisory board membership for Merck Sharp & Dohme and is co-principal investigator of clinical trials for Merck Sharp & Dohme, GlaxoSmithKline, Kite, and Bristol-Myers Squibb and cofounder and shareholder of TolerogenixX Ltd. A.S. reports travel grants from Hexal and Jazz Pharmaceuticals and a research grant from Therakos/Mallinckrodt and is cofounder and part-time employee of TolerogenixX LtD. The remaining authors declare no competing financial interests. EDAT- 2020/12/23 06:00 MHDA- 2021/05/20 06:00 PMCR- 2020/12/11 CRDT- 2020/12/22 12:37 PHST- 2020/07/24 00:00 [received] PHST- 2020/10/29 00:00 [accepted] PHST- 2020/12/22 12:37 [entrez] PHST- 2020/12/23 06:00 [pubmed] PHST- 2021/05/20 06:00 [medline] PHST- 2020/12/11 00:00 [pmc-release] AID - S2473-9529(20)31887-5 [pii] AID - 2020/ADV2020003036 [pii] AID - 10.1182/bloodadvances.2020003036 [doi] PST - ppublish SO - Blood Adv. 2020 Dec 22;4(24):6157-6168. doi: 10.1182/bloodadvances.2020003036.