OBJECTIVES: Understanding patient characteristics that influence clinical outcomes of patients with r/r LBCL treated with axi-cel can improve decision-making. We conducted a SLR and meta-analysis to identify clinical predictors of key r/r LBCL outcomes.

METHODS: We systematically searched EMBASE, MEDLINE, and 15 conferences on 1 April 2022. Real-world or clinical studies of axi-cel in r/r LBCL that included analyses of clinical predictors were eligible. Key outcomes included overall response rate (ORR), complete response (CR), overall survival (OS), progression-free survival (PFS), cytokine release syndrome (CRS), and neurotoxicity. We extracted odds ratios (OR) and hazard ratios (HR) describing the associations between potential predictors and outcomes. We used random-effects meta-analyses to estimate pooled effects. Risk of bias was assessed using the Quality in Prognosis Studies instrument.

RESULTS: From 4,280 citations, 39 publications on 22 studies were included. Infrequent use of adjusted analyses led to an overall moderate risk of bias. Using adjusted analyses for OS, patients with ECOG ≥2 were at higher risk of poor OS (HR:2.19; 95% confidence interval [CI]: 1.04-4.61), whereas patients with elevated metabolic tumor volume (MTV) were at higher risk (HR:5.26; 95%CI: 2.22-12.50). ECOG and MTV had similar effects on PFS, whereas age ≥65 was marginally protective for PFS. Reduced ORR was seen in patients with ECOG ≥2 (OR:0.36; 95%CI: 0.22-0.57), baseline IPI scores ≥3 (OR:0.41; 95%CI: 0.22-0.78), and elevated MTV (OR:0.40; 95%CI: 0.16-0.96), whereas there were no statistically significant predictors for CR. Patients aged ≥65 were at higher risk of neurotoxicity (OR:1.44; 95%CI: 1.05-1.98) and no clinical predictors were identified for CRS.

CONCLUSIONS: This study identified several clinical predictors–including ECOG, MTV, IPI and age–that were associated with outcomes of axi-cel therapy. Although this study was limited to axi-cel, further studies are warranted to examine applicability of these predictors versus other therapies.