Impact of Vein-to-vein Time in Patients With R/R LBCL Treated With Axicabtagene Ciloleucel

Chimeric antigen receptor (CAR) T-cell products axicabtagene ciloleucel (axi-cel), tisagenlecleucel (tisa-cel), and lisocabtagene maraleucel (liso-cel) are approved for relapsed/refractory large B-cell lymphoma (R/R LBCL). Emerging evidence indicates that delayed CAR T-cell infusion, including prolonged time from leukapheresis to infusion, known as vein-to-vein time (V2Vt), may adversely impact clinical outcomes. We conducted a systematic literature review (SLR) and meta-analysis to identify differences in V2Vt in patients with R/R LBCL treated with axi-cel, tisa-cel, or liso-cel. The impact of V2Vt (<28 days versus 28 to <40 days versus 40+ days) on effectiveness and safety outcomes was evaluated in patients treated with axi-cel enrolled in a post-authorization safety study using the Center for International Blood and Marrow Transplant Research data. SLR and meta-analysis showed that patients treated with axi-cel had the shortest median V2Vt (30.6 days) compared with tisa-cel (48.4 days) or liso-cel (35.9 days). Real-world analysis of patients treated with axi-cel demonstrated that V2Vt 40+ days was associated with significantly lower complete response rate compared with V2Vt <28 days (odds ratio [OR] 0.61) or 28 to <40 days (OR 0.66) and significantly worse overall survival compared with V2Vt <28 days (hazard ratio [HR] 1.33) or 28 to <40 days (HR 1.36). Higher prolonged thrombocytopenia rates were observed in patients with axi-cel V2Vt 28 to <40 days or 40+ days compared with <28 days (OR 1.44 or 1.95, respectively). Together, these results show the impact of V2Vt on patient outcomes with axi-cel therapy and that earlier infusion with CD19-CAR therapies may be beneficial.