A real-world comparison of commercial use axicabtagene ciloleucel and lisocabtagene maraleucel in large B-cell lymphoma

Lisocabtagene maraleucel (liso-cel) and axicabtagene ciloleucel (axi-cel) are anti-CD19 CAR-T therapies approved for relapsed and refractory large B cell lymphoma (R/R LBCL); however there is currently no published data on liso-cel outside of clinical trials, nor any data comparing these therapies. In this retrospective analysis, we reviewed patients receiving liso-cel or axi-cel at a single institution in the third-line setting. From June 2021 - September 2022, 50 patients received axi-cel and 37 liso-cel. Baseline patient characteristics were similar aside from older age in liso-cel recipients. Median time from leukapheresis to CAR-T infusion was significantly longer for liso-cel (41 days) than axi-cel (30 days). Complete response rates were not significantly different between axi-cel (72%) and liso-cel (62%). At a median follow-up of 11 months, progression-free survival (PFS) was not significantly different between axi-cel and liso-cel cohorts, with 12-month PFS of 59% and 44% respectively. However, on a propensity score analysis, an inferior PFS was observed with liso-cel (hazard ratio 2.95, 95% CI 1.14 - 7.60). Rates of CRS, ICANS, and prolonged neutropenia were higher with axi-cel than liso-cel. Overall, direct comparison of axi-cel and liso-cel cohorts shows similar key outcomes including response rate and PFS, but prolonged wait times for liso-cel may have resulted in biased selection of patients with more favorable characteristics for liso-cel. When accounting for these higher-risk characteristics, an inferior PFS is observed with liso-cel as compared to axi-cel. These findings warranting further evaluation in a multicenter setting.