CAR-T Outcomes Vary by Race and Ethnicity: Real-World Data from 1,290 LBCL Patients
Analysis of 1,290 real-world patients and two pivotal trials (ZUMA-1/ZUMA-7) receiving axicabtagene ciloleucel for large B-cell lymphoma revealed that non-Hispanic Black patients had lower response rates and shorter PFS than other groups, while overall survival was consistent. These disparities highlight the importance of equitable access to pre-treatment molecular profiling, CAR-T manufacturing, and standardised flow cytometric monitoring across diverse patient populations.
The original study
Real-world and clinical trial outcomes in large B-cell lymphoma with axicabtagene ciloleucel across race and ethnicity.
- Authors
- Locke FL, Siddiqi T, Jacobson CA, Ghobadi A, Ahmed S, Miklos DB, et al.
- Journal
- Blood
- Type
- Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't, Research Support, N.I.H., Extramural
- PMID
- 38635762
Original abstract
Axicabtagene ciloleucel (axi-cel) is an autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy approved for relapsed/refractory (R/R) large B-cell lymphoma (LBCL). Despite extensive data supporting its use, outcomes stratified by race and ethnicity groups are limited. Here, we report clinical outcomes with axi-cel in patients with R/R LBCL by race and ethnicity in both real-world and clinical trial settings. In the real-world setting, 1290 patients who received axi-cel between 2017 and 2020 were identified from the Center for International Blood and Marrow Transplant Research database; 106 and 169 patients were included from the ZUMA-1 and ZUMA-7 trials, respectively. Overall survival was consistent across race/ethnicity groups. However, non-Hispanic (NH) Black patients had lower overall response rate (OR, 0.37; 95% CI, 0.22-0.63) and lower complete response rate (OR, 0.57; 95% CI, 0.33-0.97) than NH White patients. NH Black patients also had a shorter progression-free survival vs NH White (HR, 1.41; 95% CI, 1.04-1.90) and NH Asian patients (HR, 1.67; 95% CI, 1.08-2.59). NH Asian patients had a longer duration of response than NH White (HR, 0.56; 95% CI, 0.33-0.94) and Hispanic patients (HR, 0.54; 95% CI, 0.30-0.97). There was no difference in cytokine release syndrome by race/ethnicity; however, higher rates of any-grade immune effector cell-associated neurotoxicity syndrome were observed in NH White patients than in other patients. These results provide important context when treating patients with R/R LBCL with CAR T-cell therapy across different racial and ethnic groups. ZUMA-1 and ZUMA-7 (ClinicalTrials.gov identifiers: #NCT02348216 and #NCT03391466, respectively) are registered on ClinicalTrials.gov.