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DRUG:
Breyanzi (lisocabtagene maraleucel)
i
Other names: anti-CD19/EGFRt/4-1BB/zeta modified CAR CD8+ and CD4+ T lymphocyte therapy, JCAR 017, liso-cel, JCAR-017, JCAR017, anti-CD19-EGFRt-4-1BB-zeta modified CAR CD8+ and CD4+ T lymphocyte therapy, CD19-CAR T cell immunotherapy, CD19 specific CAR T cells also expressing an EGFRt
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We conducted a multicenter retrospective study using the French DESCAR-T registry, including patients with LBCL who relapsed after 2L CAR T-cell therapy with axicabtagene ciloleucel or lisocabtagene maraleucel. This study represents the first real-world analysis of outcomes after relapse following 2L CAR T-cell therapy. Despite the more frequent incorporation of BsAbs into the therapeutic landscape, overall prognosis and treatment efficacy remain dismal, highlighting the urgent need for innovative therapeutic strategies and dedicated prospective trials in this emerging double-refractory population.
Liso-cel achieved deeper, more durable molecular clearance by ctDNA, consistent with superior EFS and PFS versus ASCT for second-line LBCL treatment. ctDNA-MRD provided prognostic value beyond PET, supporting its role as a complementary biomarker for treatment response and relapse prediction.
These findings highlight the importance of early leukapheresis, ideally before intensive treatments, to optimize T-cell yield, product quality, and therapeutic efficacy.
Noncovalent BTK inhibitors, particularly pirtobrutinib, has shown impressive activity in patients who have progressed on covalent BTKi. The FDA approval of lisocabtagene maraleucel represents a significant milestone in the treatment of double refractory CLL, providing a potentially curative option for eligible patients. The development of effective treatments for double refractory CLL represents an urgent unmet clinical need and the promising results from emerging therapies offer hope for improved outcomes in this challenging patient population.