EFFICACY OF CAR T-CELL THERAPY IN RELAPSED OR REFRACTORY FOLLICULAR LYMPHOMA: A SYSTEMATIC REVIEW AND META-ANALYSIS
Author(s)
Mohammed Zuber, PharmD, Shaimaa Elshafie, Ph.D, Lorenzo Villa Zapata, PharmD, PhD;
University of Georgia, Athens, GA, USA
University of Georgia, Athens, GA, USA
OBJECTIVES: Chimeric antigen receptor T-cell (CAR-T) therapy has emerged as a promising treatment for relapsed or refractory follicular lymphoma; however, reported efficacy outcomes vary across studies. This systematic review and meta-analysis aimed to evaluate the efficacy of CAR-T therapy in patients with relapsed or refractory follicular lymphoma, focusing on overall response rate (ORR), complete response (CR), progression-free survival (PFS), and overall survival (OS).
METHODS: A systematic search was conducted in PubMed/MEDLINE and Embase in February 2025, supplemented by ClinicalTrials.gov. Studies evaluating CAR-T therapy efficacy in adults with relapsed or refractory follicular lymphoma were eligible. Two reviewers independently screened studies using the Rayyan tool. Risk of bias was assessed using ROBINS-I for non-randomized studies. Pooled proportions with 95% confidence intervals (CIs) were estimated for ORR, CR, 1-year PFS, and 1-year OS rates using random effects models. Heterogeneity was assessed using I² statistics.
RESULTS: Eleven studies (27 reports) comprising single-arm CAR-T trials were included. CAR-T products evaluated included tisagenlecleucel, axicabtagene ciloleucel, lisocabtagene maraleucel, and other investigational anti-CD19 therapies. Across studies, ORR ranged from 82.6% to 100%. The pooled ORR was 91% (95% CI: 86%-94%), and the pooled CR rate was 77% (95% CI: 66%-86%). The pooled 1-year PFS rate was 62% (95% CI: 44%-77%), and the pooled 1-year OS rate was 89% (95% CI: 67%-97%), with substantial heterogeneity observed for both outcomes (I² >80%). Risk of bias was moderate to high in more than half of the included studies.
CONCLUSIONS: CAR-T therapy demonstrates high response rates and durable short-term survival outcomes in patients with relapsed or refractory follicular lymphoma. However, outcome heterogeneity and moderate-to-high risk of bias across studies highlight the need for longer-term follow-up and comparative studies to better inform treatment selection and health policy decisions.
METHODS: A systematic search was conducted in PubMed/MEDLINE and Embase in February 2025, supplemented by ClinicalTrials.gov. Studies evaluating CAR-T therapy efficacy in adults with relapsed or refractory follicular lymphoma were eligible. Two reviewers independently screened studies using the Rayyan tool. Risk of bias was assessed using ROBINS-I for non-randomized studies. Pooled proportions with 95% confidence intervals (CIs) were estimated for ORR, CR, 1-year PFS, and 1-year OS rates using random effects models. Heterogeneity was assessed using I² statistics.
RESULTS: Eleven studies (27 reports) comprising single-arm CAR-T trials were included. CAR-T products evaluated included tisagenlecleucel, axicabtagene ciloleucel, lisocabtagene maraleucel, and other investigational anti-CD19 therapies. Across studies, ORR ranged from 82.6% to 100%. The pooled ORR was 91% (95% CI: 86%-94%), and the pooled CR rate was 77% (95% CI: 66%-86%). The pooled 1-year PFS rate was 62% (95% CI: 44%-77%), and the pooled 1-year OS rate was 89% (95% CI: 67%-97%), with substantial heterogeneity observed for both outcomes (I² >80%). Risk of bias was moderate to high in more than half of the included studies.
CONCLUSIONS: CAR-T therapy demonstrates high response rates and durable short-term survival outcomes in patients with relapsed or refractory follicular lymphoma. However, outcome heterogeneity and moderate-to-high risk of bias across studies highlight the need for longer-term follow-up and comparative studies to better inform treatment selection and health policy decisions.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO146
Topic
Clinical Outcomes
Topic Subcategory
Clinician Reported Outcomes, Comparative Effectiveness or Efficacy
Disease
SDC: Oncology, STA: Multiple/Other Specialized Treatments