OBJECTIVES: Chimeric antigen receptor (CAR) T cell therapy is a treatment option proven to be effective in trials and real-world clinical settings among patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL). The United States (US) Food and Drug Administration has approved three such therapies for R/R DLBCL. This study aimed to understand how patients with R/R DLBCL value benefits and risks associated with CAR T cell therapy.

METHODS: A web-based best-best discrete choice experiment (BB-DCE) was administered to adults with self-reported diagnosis of R/R DLBCL. The BB-DCE included nine experimentally designed choice tasks consisting of three hypothetical treatment profiles, including a fixed profile representing standard of care (non–CAR T). Treatments were described by six attributes: two-year treatment success (probability of being alive and in remission), dosing schedule, administration location, risk of acute treatment reactions (cytokine release syndrome, neurological events), risk of serious infections, and severity of chronic side effects. A mixed logit model was used to estimate preference weights, calculate relative attribute importance (RAI), and quantify attribute trade-offs.

RESULTS: Ninety-five US respondents completed the survey. Mean age was 61 years; 52.6% of respondents were male. Forty-three percent of respondents were eligible for stem cell transplant or had received it; 68% were currently on second-line treatment. Probability of treatment success had the largest influence on treatment preferences (RAI 45.3%), followed by risk of serious infections (RAI 19.6%) and acute treatment reactions (RAI 14.7%). Participants were willing to accept a 69.5% increase in risk of serious infections to increase chance of treatment success from 5% to 45%. No statistically significant differences in RAI were observed in subgroups by treatment line, stem cell transplant eligibility, or ECOG PS.

CONCLUSIONS: Treatment efficacy was a key driver of preferences. Patients tolerated potential increases in treatment-related risks to improve chances of survival and remission at two years.