Systematic Review of Prognostic Factors for Efficacy and Safety Outcomes in CAR-T Cell Therapy for Diffuse Large B-cell Lymphoma
Author(s)
Jonas Jost1, Jörg Mahlich, PhD2, Sybille Riou, PharmD3, Peter Borchmann, Prof. Dr. med.4, Stefan Walzer, MA, PhD1, Jan-Michel Heger, Dr.5, Julia Schleifenbaum, Dr.5.
1MArS Market Access & Pricing Strategy GmbH, Weil am Rhein, Germany, 2Miltenyi Biomedicine, Bergisch Gladbach, Germany, 3Miltenyi Biomedicine GmbH, Bergisch Gladbach, Germany, 4Department I of Internal Medicine, Center for Integrated Oncology, Cologne, Germany, 5UK Koeln, Koeln, Germany.
1MArS Market Access & Pricing Strategy GmbH, Weil am Rhein, Germany, 2Miltenyi Biomedicine, Bergisch Gladbach, Germany, 3Miltenyi Biomedicine GmbH, Bergisch Gladbach, Germany, 4Department I of Internal Medicine, Center for Integrated Oncology, Cologne, Germany, 5UK Koeln, Koeln, Germany.
OBJECTIVES: To systematically identify and evaluate prognostic factors influencing efficacy and safety outcomes of chimeric antigen receptor T-cell (CAR-T) therapies in diffuse large B-cell lymphoma (DLBCL) patients.
METHODS: A systematic literature review was conducted using PubMed, Cochrane, and EMBASE databases. Studies reporting on prognostic factors for overall survival (OS), progression-free survival (PFS), complete response rate (CRR), objective response rate (ORR), duration of response (DoR), best overall response (BOR), and safety outcomes (cytokine release syndrome [CRS] and immune effector cell-associated neurotoxicity syndrome [ICANS]) in DLBCL patients treated with CAR-T therapy were included. Data were extracted and analysed according to PRISMA guidelines.
RESULTS: From 712 identified articles, 79 met inclusion criteria. Key prognostic factors for efficacy outcomes included Eastern Cooperative Oncology Group Performance Status (ECOG PS), lactate dehydrogenase (LDH) levels, International Prognostic Index (IPI), disease histology, and Ann Arbor stage. High LDH, ECOG PS ≥2, and higher disease burden were consistently associated with poorer outcomes. CAR-T expansion and persistence were positively associated with improved efficacy. For safety outcomes, several factors were identified as risk indicators. Among these, elevated interleukin levels, high ferritin, and high tumour burden were notably associated with increased CRS risk. Similarly, various blood markers, including but not limited to ferritin and neurofilament light chain levels, were linked to higher ICANS risk.
CONCLUSIONS: This review provides a comprehensive overview of prognostic factors influencing CAR-T therapy outcomes in DLBCL. The identified factors can aid in patient selection, risk stratification, and treatment optimization. Further research is needed to validate these factors in prospective studies and integrate them into clinical decision-making processes.
METHODS: A systematic literature review was conducted using PubMed, Cochrane, and EMBASE databases. Studies reporting on prognostic factors for overall survival (OS), progression-free survival (PFS), complete response rate (CRR), objective response rate (ORR), duration of response (DoR), best overall response (BOR), and safety outcomes (cytokine release syndrome [CRS] and immune effector cell-associated neurotoxicity syndrome [ICANS]) in DLBCL patients treated with CAR-T therapy were included. Data were extracted and analysed according to PRISMA guidelines.
RESULTS: From 712 identified articles, 79 met inclusion criteria. Key prognostic factors for efficacy outcomes included Eastern Cooperative Oncology Group Performance Status (ECOG PS), lactate dehydrogenase (LDH) levels, International Prognostic Index (IPI), disease histology, and Ann Arbor stage. High LDH, ECOG PS ≥2, and higher disease burden were consistently associated with poorer outcomes. CAR-T expansion and persistence were positively associated with improved efficacy. For safety outcomes, several factors were identified as risk indicators. Among these, elevated interleukin levels, high ferritin, and high tumour burden were notably associated with increased CRS risk. Similarly, various blood markers, including but not limited to ferritin and neurofilament light chain levels, were linked to higher ICANS risk.
CONCLUSIONS: This review provides a comprehensive overview of prognostic factors influencing CAR-T therapy outcomes in DLBCL. The identified factors can aid in patient selection, risk stratification, and treatment optimization. Further research is needed to validate these factors in prospective studies and integrate them into clinical decision-making processes.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
CO231
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment
Disease
Oncology, Personalized & Precision Medicine