Treatment Patterns Post-CAR T Cell Therapy in Patients With Hematologic Malignancies: A Real-World US Study
Author(s)
Mohammed Zuber, PharmD1, Shaimaa Elshafie, MSc1, Shifa Taj, PharmD2, Lorenzo Villa Zapata, PharmD, PhD1;
1University of Georgia, Athens, GA, USA, 2Independent Researcher, Bengaluru, India
1University of Georgia, Athens, GA, USA, 2Independent Researcher, Bengaluru, India
OBJECTIVES: Chimeric Antigen Receptor T (CAR-T) cell therapy has revolutionized the treatment of hematologic malignancies, offering improved outcomes since its approval in 2017. However, limited evidence exists on treatment patterns and clinical outcomes following CAR-T failure or relapse. This study evaluates real-world treatment patterns and the cumulative risk of subsequent therapies in patients who underwent CAR-T therapy.
METHODS: This retrospective cohort study utilized the 2017-2022 Merative MarketScan database to identify commercially insured patients with acute lymphoblastic leukemia (ALL), diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), mantle cell lymphoma (MCL), or primary mediastinal large B-cell lymphoma (PMBCL) who received CAR-T cell therapy. The index date was the CAR-T administration date, with a 6-month pre-index eligibility requirement. Patients were followed until insurance disenrollment or December 31, 2022. Subsequent therapy was used as a proxy for CAR-T failure or relapse, and cumulative risk was estimated using the Kaplan-Meier method.
RESULTS: Of 10,024 patients with hematologic malignancies, 246 patients were eligible and included in the study. Most patients were diagnosed with DLBCL (n= 185; 75.2%), while the remaining cases included MCL (n= 23), ALL (n= 22), FL (n= 15), and PMBCL (n= 1). The mean age of patients was 53.2 years (SD:10.7), and 69.9% were male. A total of 110 patients (44.7%) initiated a subsequent therapy. The median time to the first subsequent therapy was 263 days (95% CI: 190-423). Common subsequent therapies included systematic chemotherapy (80.9%), radiotherapy (37.3%), lenalidomide (20.0%), ibrutinib (10.0%), venetoclax (5.4%), and allogeneic stem cell transplantation (2.7%). The cumulative risk of initiating subsequent therapy was 38.1% (95% CI: 31.7%-45.2%) at 6 months and 56.1% (95% CI: 48.4%-64.1%) at 12 months.
CONCLUSIONS: A significant proportion of CAR-T therapy recipients required subsequent treatment, indicating a critical unmet need for effective salvage therapies to improve clinical outcomes in this population.
METHODS: This retrospective cohort study utilized the 2017-2022 Merative MarketScan database to identify commercially insured patients with acute lymphoblastic leukemia (ALL), diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), mantle cell lymphoma (MCL), or primary mediastinal large B-cell lymphoma (PMBCL) who received CAR-T cell therapy. The index date was the CAR-T administration date, with a 6-month pre-index eligibility requirement. Patients were followed until insurance disenrollment or December 31, 2022. Subsequent therapy was used as a proxy for CAR-T failure or relapse, and cumulative risk was estimated using the Kaplan-Meier method.
RESULTS: Of 10,024 patients with hematologic malignancies, 246 patients were eligible and included in the study. Most patients were diagnosed with DLBCL (n= 185; 75.2%), while the remaining cases included MCL (n= 23), ALL (n= 22), FL (n= 15), and PMBCL (n= 1). The mean age of patients was 53.2 years (SD:10.7), and 69.9% were male. A total of 110 patients (44.7%) initiated a subsequent therapy. The median time to the first subsequent therapy was 263 days (95% CI: 190-423). Common subsequent therapies included systematic chemotherapy (80.9%), radiotherapy (37.3%), lenalidomide (20.0%), ibrutinib (10.0%), venetoclax (5.4%), and allogeneic stem cell transplantation (2.7%). The cumulative risk of initiating subsequent therapy was 38.1% (95% CI: 31.7%-45.2%) at 6 months and 56.1% (95% CI: 48.4%-64.1%) at 12 months.
CONCLUSIONS: A significant proportion of CAR-T therapy recipients required subsequent treatment, indicating a critical unmet need for effective salvage therapies to improve clinical outcomes in this population.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO114
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment, Performance-based Outcomes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology, STA: Genetic, Regenerative & Curative Therapies