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Chimeric Antigen Receptor T Cells in Large B-Cell Lymphoma: Analysis of Overall Survival Based on Reconstructed Patient-Level Data

      Abstract

      Purpose

      Chimeric antigen receptor (CAR) T-cell products (eg, tisagenlecleucel [tisa], axicabtagene ciloleucel [axi]) have been used in patients with relapsed/refractory large B-cell lymphoma (LBCL) and in adult patients with acute lymphoblastic leukemia (ALL). After the recent publication of long-term follow-up data in LBCL, reviewing the evidence on this topic is worthwhile. The aim of the present work was to study the pattern of overall survival (OS) reported for CAR T-cell products in LBLC and ALL.

      Methods

      A standard literature search was performed. OS was studied through an artificial intelligence technique (the Shiny method) that reconstructs individual patient data from published Kaplan-Meier curves. Standard statistics along with indirect comparisons were performed on these reconstructed data. Indirect comparisons focused on CAR T cells versus chemotherapy in LBCL and ALL; tisa and axi were further indirectly compared in LBCL.

      Findings

      Seven trials were included (4 for LBCL, 3 for ALL). Other populations were selected as control groups. The main results of our analysis were: (1) the survival advantage of CAR T cells is greater in adult patients with ALL than in patients with LBCL; and (2) for LBCL, the survival gain is more substantial for axi compared with tisa.

      Implications

      Our results are helpful to define the place in therapy of CAR T cells in these 2 disease conditions and also suggest preliminary estimates of cost-effectiveness. One strength of our analysis is that extensive information was available for the treatment options included in indirect comparisons. The main weakness is the inability of the Shiny method to perform multivariate analyses.

      Key words

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