Inferior survival in double refractory large B-cell lymphoma eligible for third-line CD19 CAR T-cell therapy
Bibliographic record
Abstract
Outcomes following CD19 chimeric antigen receptor (CAR) T-cell therapy in third-line treatment and beyond for patients with large B-cell lymphoma (LBCL) refractory to both an anthracycline during initial and platinum-based salvage therapy, referred to as double refractory (DR), are not well-described. It is also unclear if these patients may be less likely to proceed to CAR T-cell infusion. Our objectives were to assess third-line CAR T-cell survival outcomes in DR- and non-DR (NDR)-LBCL cohorts including the failure rates to proceed to cell infusion. Review of 199 patients with LBCL referred for CAR T-cell treatment at our center, demonstrates that the DR-LBCL patients (n = 68) have an inferior 12-month (overall survival [OS], 47.1% vs 66.7%, respectively;) when compared to the patients with NDR-LBCL (n = 131). This OS difference is driven by a higher failure rate to proceed to CAR T-cell infusion (32% vs 18%). For patients unable to proceed to CAR T-cell infusion median OS was 2.56 months; DR-LBCL 1.94 months vs NDR-LBCL 3.42 months. The 12-month OS (65% vs 72.3%) and 6-month progression-free survival (46.5% vs 57.2%) of patients with DR- and NDR-LBCL proceeding to CAR T-cell infusion, appears similar. Our study highlights a high-risk subgroup characterized by inferior OS with challenges in getting to CAR T-cell infusion and could benefit from different management approaches such as novel bridging or "off-the-shelf" strategies.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".