Chimeric Antigen Receptor T-Cell Therapy (CAR-T) Utilization Patterns for Relapsed/Refractory (R/R) Diffuse Large B-Cell Lymphoma (DLBCL) Among United States (US) Community Hematologists/Oncologists (CH/OS)
Author(s)
Feinberg B1, Klink A2, Schuler T3, Balanean, MPH A2, McAllister L2, Liassou D2, Gajra A2, Porter D4
1Cardinal Health Specialty Solutions, ATLANTA, GA, USA, 2Cardinal Health Specialty Solutions, Dublin, OH, USA, 3Cardinal Health Specialty Solutions, Issaquah, WA, USA, 4Cell Therapy and Transplant Program, Hematology Oncology Division and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
Presentation Documents
OBJECTIVES:
Patients with R/R DLBCL are initially treated by cH/Os and require referral for CAR-T. Aspects of the patient’s complex journey are not well understood. This study assessed CAR-T recipient care from the cH/O perspective.METHODS:
This was a retrospective, observational, multicenter study of R/R DLBCL CAR-T recipients in 2019. Charts were abstracted by treating cH/Os capturing treatment patterns and outcomes. Data were compared by months from initial diagnosis to CAR-T (<18 [n=29] or >18 [n=36]) using a <18-month surrogate endpoint for poor prognosis (e.g., refractory disease, rapid progression) and chi-square, Fisher exact, or t-tests. Data were also described by patients’ US regions.RESULTS:
13 cH/Os identified 65 patients. Most (92%) received first-line R + CHOP, had median 2 pre-CAR-T therapies (range 1-4), 32% prior autologous stem cell transplantation (ASCT), 60% axicabtagene ciloleucel (axi-cel), 39% tisagenlecleucel (tisa-cel), and 2% had lisocabtagene maraleucel. Patients with >18 months between initial diagnosis and CAR-T were more likely to receive ASCT (53% vs 7%, P=0.0056) and have longer median overall survival (OS) post-CAR-T (64.8 vs 40.3 months, P=0.0488). Median times to key events for the overall sample were: referral to leukapheresis (LP), 4.6 weeks; LP to CAR-T, 3.6 weeks. Patient distributions within each US region of Northeast [NE] (n=19, 29%), Midwest [MW] (n=6, 9%), South [S] (n=14, 22%), and West [W] (n=26, 40%), respectively, were: time to CAR-T <18 months (n=29, 45%): (n=14, 74%), (n=2, 33%), (n=2, 14%), (n=11, 42%) (P=0.0056); pre-CAR-T ASCT (n=21, 32%): (n=2, 11%), (n=5, 83%), (n=10, 71%), (n=4, 15%) (P<0.0001); axi-cel (n=39, 60%): (n=9, 47%), (n=1, 17%), (n=14, 100%), (n=15, 58%) (P=0.0006); and tisa-cel (n=25, 39%): (n=10, 53%), (n=5, 83%), (n=0, 0%), and (n=10, 39%) (P=0.0006). CONCLUSION: Regional differences in important CAR-T patterns and outcomes were observed. Shorter OS from diagnosis to CAR-T <18 months is consistent with recent trials.Conference/Value in Health Info
2022-05, ISPOR 2022, Washington, DC, USA
Value in Health, Volume 25, Issue 6, S1 (June 2022)
Code
CO99
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment
Disease
Oncology