Chimeric antigen receptor t-cell therapy (car-t) utilization patterns for relapsed/refractory (r/r) diffuse large b-cell lymphoma (dlbcl) among united states (us) community hematologists/oncologists (ch/os)

Patients with R/R DLBCL are initially treated by cH/Os and require referral for CAR-T. Aspects of the patient’s complex journey are not well understood. This study assessed CAR-T recipient care from the cH/O perspective. This was a retrospective, observational, multicenter study of R/R DLBCL CAR-T recipients in 2019. Charts were abstracted by treating cH/Os capturing treatment patterns and outcomes. Data were compared by months from initial diagnosis to CAR-T (≤18 [n=29] or >18 [n=36]) using a <18-month surrogate endpoint for poor prognosis (e.g., refractory disease, rapid progression) and chi-square, Fisher exact, or t-tests. Data were also described by patients’ US regions. 13 cH/Os identified 65 patients. Most (92%) received first-line R + CHOP, had median 2 pre-CAR-T therapies (range 1-4), 32% prior autologous stem cell transplantation (ASCT), 60% axicabtagene ciloleucel (axi-cel), 39% tisagenlecleucel (tisa-cel), and 2% had lisocabtagene maraleucel. Patients with >18 months between initial diagnosis and CAR-T were more likely to receive ASCT (53% vs 7%, P=0.0056) and have longer median overall survival (OS) post-CAR-T (64.8 vs 40.3 months, P=0.0488). Median times to key events for the overall sample were: referral to leukapheresis (LP), 4.6 weeks; LP to CAR-T, 3.6 weeks. Patient distributions within each US region of Northeast [NE] (n=19, 29%), Midwest [MW] (n=6, 9%), South [S] (n=14, 22%), and West [W] (n=26, 40%), respectively, were: time to CAR-T ≤18 months (n=29, 45%): (n=14, 74%), (n=2, 33%), (n=2, 14%), (n=11, 42%) (P=0.0056); pre-CAR-T ASCT (n=21, 32%): (n=2, 11%), (n=5, 83%), (n=10, 71%), (n=4, 15%) (P<0.0001); axi-cel (n=39, 60%): (n=9, 47%), (n=1, 17%), (n=14, 100%), (n=15, 58%) (P=0.0006); and tisa-cel (n=25, 39%): (n=10, 53%), (n=5, 83%), (n=0, 0%), and (n=10, 39%) (P=0.0006). Regional differences in important CAR-T patterns and outcomes were observed. Shorter OS from diagnosis to CAR-T ≤18 months is consistent with recent trials.