Journal: Blood advances
This study evaluated real-world outcomes of adults with relapsed/refractory large B‑cell lymphoma in Canada who would have been eligible for anti‑CD19 CAR T-cell therapy under current criteria.
Design
- Compared groups: Patients treated with CAR T-cells (n = 85, post‑funding era) were compared with historical controls (n = 150) treated before CAR T availability but who met current eligibility.
- Methods: Propensity-weighted methods were used to balance baseline characteristics.
- Follow-up: 3 years, assessing survival and health care resource use.
Key efficacy outcomes
- Overall survival at 3 years
- CAR-T: 59% (95% CI, 42–72; median not reached)
- Historical controls: 10% (95% CI, 5–16; median 4.4 months)
- Hazard ratio for death: 0.21 (95% CI, 0.14–0.31), favoring CAR-T.
- Progression-free survival at 3 years
- CAR-T: 48% (95% CI, 32–63; median 14.4 months)
- Historical controls: 6% (95% CI, 3–11; median 3.6 months)
- Hazard ratio for progression or death: 0.28 (95% CI, 0.20–0.39).
Health care resource use
Per 1000 person-days at risk, CAR-T recipients had:
- Fewer hospital admissions: 5.32 vs 9.10
- Fewer emergency department visits: 2.33 vs 4.81
- Fewer ICU admissions: 0.53 vs 1.25
- Lower hospitalization rates for:
- Fever: 0.93 vs 1.63
- Infection: 1.48 vs 3.08
- Neutropenia: 0.66 vs 1.97
All differences were statistically significant (P < .001).
Conclusion
In a large, real-world Canadian cohort of eligible patients with relapsed/refractory large B‑cell lymphoma, anti‑CD19 CAR T-cell therapy was associated with substantially improved 3‑year overall and progression‑free survival and, despite known CAR-T toxicities, lower rates of hospital-based resource use compared with prior standard salvage therapies, highlighting both its clinical effectiveness and favorable health system impact.