Efficacy of chimeric antigen receptor T cell therapy and autologous stem cell transplant in relapsed or refractory diffuse large B-cell lymphoma: A systematic review

Linyan Tian, Cheng Li, Juan Sun, Yixin Zhai, Jinhuan Wang, Su Liu, Yanan Jiang, Wenqi Wu, Donghui Xing, Yangyang Lv, Jing Guo, Hong Xu, Huimeng Sun, Yuhang Li, Lanfang Li, Zhigang Zhao, Linyan Tian, Cheng Li, Juan Sun, Yixin Zhai, Jinhuan Wang, Su Liu, Yanan Jiang, Wenqi Wu, Donghui Xing, Yangyang Lv, Jing Guo, Hong Xu, Huimeng Sun, Yuhang Li, Lanfang Li, Zhigang Zhao

Abstract

Background: We aimed to compare the efficacy of chimeric antigen receptor T (CAR-T) cell therapy with that of autologous stem cell transplantation (auto-HSCT) in relapsed/refractory diffuse large B cell lymphoma (R/R DLBCL).

Research design and methods: We searched eligible publications up to January 31st, 2022, in PubMed, Cochrane Library, Springer, and Scopus. A total of 16 publications with 3484 patients were independently evaluated and analyzed using STATA SE software.

Results: Patients who underwent CAR-T cell therapy showed a better overall response rate (ORR) and partial response (PR) than those treated with auto-HSCT (CAR-T vs. auto-HSCT, ORR: 80% vs. 73%, HR:0.90,95%CI:0.76-1.07,P = 0.001; PR: 20% vs. 14%, HR:0.65,95%CI:0.62-0.68,P = 0.034). No significant difference was observed in 6-month overall survival (OS) (CAR-T vs. auto-HSCT, six-month OS: 81% vs. 84%, HR:1.23,95%CI:0.63-2.38, P = 0.299), while auto-HSCT showed a favorable 1 and 2-year OS (CAR-T vs. auto-HSCT, one-year OS: 64% vs. 73%, HR:2.42,95%CI:2.27-2.79, P < 0.001; two-year OS: 54% vs. 68%, HR:1.81,95%CI:1.78-1.97, P < 0.001). Auto-HSCT also had advantages in progression-free survival (PFS) (CAR-T vs. auto-HSCT, six-month PFS: 53% vs. 76%, HR:2.81,95%CI:2.53-3.11,P < 0.001; one-year PFS: 46% vs. 61%, HR:1.84,95%CI:1.72-1.97,P < 0.001; two-year PFS: 42% vs. 54%, HR:1.62,95%CI:1.53-1.71, P < 0.001). Subgroup analysis by age, prior lines of therapy, and ECOG scores was performed to compare the efficacy of both treatment modalities.

Conclusion: Although CAR-T cell therapy showed a beneficial ORR, auto-HSCT exhibited a better long-term treatment superiority in R/R DLBCL patients. Survival outcomes were consistent across different subgroups.

Keywords: CAR-T cell; R/R DLBCL; auto-HSCT; meta-analysis; survival.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2023 Tian, Li, Sun, Zhai, Wang, Liu, Jiang, Wu, Xing, Lv, Guo, Xu, Sun, Li, Li and Zhao.

Figures

Figure 1
Figure 1
(A) Flow diagram of selecting eligible studies Forest plot of (B) ORR (C) PR (D) CR between CAR-T and auto-HSCT groups.
Figure 2
Figure 2
Forest plot of OS between CAR-T and auto-HSCT groups (A) 6-month OS (B) 1-year OS (C) 2-year OS Forest plot of PFS between CAR-T and auto-HSCT groups (D) 6-month PFS (E) 1-year PFS (F) 2-year PFS.
Figure 3
Figure 3
Subgroup analyses by age between CAR-T and auto-HSCT groups (A) ORR (B) CR (C) 2-year OS (D) 2-year PFS.
Figure 4
Figure 4
Subgroup analysis by previous therapeutic lines between CAR-T and auto-HSCT groups (A) 2-year OS (B) 2-year PFS (C) ORR.
Figure 5
Figure 5
Subgroup analysis by ECOG scores between CAR-T and auto-HSCT groups (A) ORR (B) CR.

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