Axicabtagene Ciloleucel in Relapsed or Refractory Large B-Cell Lymphoma Patients in Complete Metabolic Response at Time of Infusion

Introduction. Suboptimal CAR T-cell stimulation, expansion, and persistence is of theoretical concern in absence of CD19+ tumor B-cells. Adequate CAR T-cell expansion has been reported in the JULIET study among 7 relapsed or refractory (r/r) large B-cell lymphoma (LBCL) patients who had achieved complete metabolic remission (CMR) before tisagenlecleucel (tisa-cel) infusion. As patients in CMR at time of infusion were excluded from the ZUMA-1 trial, the efficacy of axicabtagene ciloleucel (axi-cel), whose construct and kinetics differ significantly from those of tisa-cel, remains unknown in this population. Methods. This is a retrospective study of all patients with r/r LBCL treated with standard of care (SOC) axi-cel at MD Anderson Cancer Center between 01/2018 and 02/2021 (data cut-off 04/2021). CMR was defined as a Deauville score = 3 (58% vs 10%, p=0.006), elevated lactate dehydrogenase (LDH)(70% vs 10%, p