Health-Related Quality of Life (HRQoL) of Large B-cell Lymphoma (LBCL) and Follicular Lymphoma (FL) Patients Treated with Axicabtagene Ciloleucel (Axi-cel) in Clinical Trials and the Real-World: A Targeted Literature Review

OBJECTIVES: Axi-cel is an autologous anti-CD19 chimeric antigen receptor T-cell therapy approved for LBCL and FL treatment. With efficacy and safety characteristics well-understood, we sought to better comprehend the impact of axi-cel on HRQoL through a targeted literature review.
METHODS: Eligible publications pertained to trials and observational studies reporting select patient-reported outcomes (PROs) by lymphoma patients treated with axi-cel (> 60% of patients). Publications were identified using: 1. Systematic Embase search (2017-September 17, 2024); 2. Snowball approach; and 3. Hand searches of conference abstracts. Data were extracted in tandem.
RESULTS: 19 eligible publications (11 peer-reviewed publications and 8 conference presentations) reporting on 11 unique studies were identified. Eight were real-world cohorts and three were clinical trials. Studies were conducted globally, but mainly in the US and Europe. The studies reported a wide range of PROs, including 43 scales and subscales, but many were reported only once. The EORTC QLQ-C30 and its subscales were the most commonly reported. Four studies consistently showcased an initial dip in the first 2-8 weeks following axi-cel infusion, a recovery to baseline at 1-3 month(s), and improvements through to 12 months. ZUMA-7 demonstrated a faster recovery with axi-cel than standard-of-care and a Moffitt Cancer Center axi-cel cohort suggested HRQoL realignment with the general population. Other measures reporting at similar timepoints (e.g., EQ-5D-5L) further supported the dip-recovery-improvement trends in functionality and symptoms, while measures reporting up to 30-90 days (e.g., MDASI) seldomly showed improvements. Neurocognitive outcomes were reported less frequently, and trends were more heterogeneous. The evidence base included mostly LBCL patients, making it unclear whether trends were similar or different for FL patients.
CONCLUSIONS: Studies identified highlight the overall improved HRQoL of patients treated with axi-cel. Patients experienced substantial and generally quick recovery in functionality and symptoms across a breadth of HRQoL measures, emphasizing axi-cel’s benefits beyond clinical efficacy.