All content on this site is intended for healthcare professionals only. By acknowledging this message and accessing the information on this website you are confirming that you are a Healthcare Professional. If you are a patient or carer, please visit the Lymphoma Coalition.

The Lymphoma Hub uses cookies on this website. They help us give you the best online experience. By continuing to use our website without changing your cookie settings, you agree to our use of cookies in accordance with our updated Cookie Policy

An expert panel hosted by

The Lymphoma Hub logo and the Multiple Myeloma Hub logo

Sequencing immune-based therapies in B-cell malignancies

with Ulric Jäger, Sagar Lonial, and Krina Patel

Saturday, June 15 | 18:00-19:30 CEST

Register now

This independent education activity is sponsored by Bristol Myers Squibb. All content is developed independently by the faculty. Funders are allowed no direct influence on the content of this activity.


The Lymphoma Hub website uses a third-party service provided by Google that dynamically translates web content. Translations are machine generated, so may not be an exact or complete translation, and the Lymphoma Hub cannot guarantee the accuracy of translated content. The Lymphoma Hub and its employees will not be liable for any direct, indirect, or consequential damages (even if foreseeable) resulting from use of the Google Translate feature. For further support with Google Translate, visit Google Translate Help.

Steering CommitteeAbout UsNewsletterContact
You're logged in! Click here any time to manage your account or log out.
You're logged in! Click here any time to manage your account or log out.

Axi-cel vs chemoimmunotherapy in older patients with R/R LBCL

May 10, 2024
Learning objective: After reading this article, learners will be able to cite a new development in the treatment of patients with relapsed/refractory large B-cell lymphoma.

Bookmark this article

Older patients with relapsed/refractory (R/R) large B-cell lymphoma (LBCL) have poor outcomes with standard salvage chemotherapy and stem cell transplantation.1 Additionally, older patients and/or patients with poor Eastern Cooperative Oncology Group Performance Status (ECOG PS) have limited treatment options. Axicabtagene ciloleucel (axi-cel), an autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy, is approved by the U.S. Food and Drug Administration (FDA) as a second-line treatment for patients with LBCL. A post-hoc analysis from the ZUMA-1 trial (NCT02348216) and a survival analysis from the ZUMA-7 trial (NCT03391466) demonstrated the effectiveness of axi-cel in patients aged ≥65 years with R/R LBCL.1

Below, we summarize results from an analysis comparing real-world outcomes of axi-cel vs chemoimmunotherapy (CIT) in patients with R/R LBCL after ≥2 lines of therapy, including patients aged ≥65 years and/or had an ECOG PS of 2, published by Lunning et al.1 in American Journal of Hematology.

Study design and patient population1

  • This analysis compared outcomes of 1,146 patients from the Centre for International Blood and Marrow Transplant Research (CIBMTR) observational database treated with axi-cel vs 469 patients who received CIT from the retrospective SCHOLAR-1 study.
  • Endpoints included overall response rate, complete response rate, and overall survival (OS).
  • Median follow-up was 24.5 months (95% confidence interval [CI], 24.3–24.9) and 59.8 months (95% CI, 52.3–65.0) in the axi-cel and CIT groups, respectively.

Key findings1

Patient characteristics

  • Before propensity score matching, patients in the axi-cel group were older, more likely to have ECOG PS <2, and were more heavily pretreated (Table 1).
  • After propensity score matching:
    • The response rate analysis set included 493 and 289 patients from the axi-cel and CIT groups, respectively.
    • The survival analysis set included 659 and 406 patients from the axi-cel and CIT groups, respectively.

Table 1. Patient characteristics*

Baseline characteristics, % (unless otherwise specified)


(n = 1,146)


(n = 469)

Median age, years (range)

62.3 (19.6–86.2)

55.4 (19.8–81.2)

              <65 years



              ≥65 years



              ≥70 years















Prior lines of therapy









Axi-cel, axicabtagene ciloleucel; CIT, chemoimmunotherapy; ECOG PS, Eastern Cooperative Oncology Group Performance Status.
*Adapted from Lunning, et al.1


  • The estimated 12-month OS rate was 62% (95% CI, 58–66) and 28% (95% CI, 24–33) in the axi-cel and CIT groups, respectively.
  • Median OS was longer in axi-cel vs CIT groups, respectively (hazard ratio [HR], 0.30; 95% CI 0.24–0.37) as well as in the subgroups:
    • <65 years: HR, 0.29 (95% CI, 0.22–0.28)
    • ≥65 years: HR, 0.32 (95% CI, 0.22–0.48)
    • ECOG PS <2: HR, 0.27 (95% CI, 0.20–0.35)
    • ECOG PS = 2: HR, 0.72 (95% CI 0.41–1.29).
  • The overall response rate and complete response rates were also higher in the axi-cel vs the CIT group (Figure 1).

Figure 1. Response rate analysis showing A ORR and B CR rates in the axi-cel group vs CIT group* 

Axi-cel, axicabtagene ciloleucel; CIT, chemoimmunotherapy; CR, complete response; ECOG PS, Eastern Cooperative Oncology Group performance status; ORR, overall response rate.
*Adapted from Lunning, et al.1


Key learnings
  • This real-world analysis demonstrated the benefit of axi-cel over CIT in patients with R/R LBCL.
  • The improved response rates were more pronounced in patients aged ≥65 years, suggesting these patients in particular may benefit from axi-cel treatment.
  • These results support the use of axi-cel therapy in older patients and/or patients with a poorer ECOG PS with R/R LBCL.

  1. Lunning MA, Wang HL, Hu ZH, et al. Benefit of axicabtagene ciloleucel versus chemoimmunotherapy in older patients and/or patients with poor ECOG performance status with relapsed or refractory large B-cell lymphoma after 2 or more lines of prior therapy. AM J Hematol. 2024;99(5):880-889. DOI: 1002/ajh.27283

Understanding your specialty helps us to deliver the most relevant and engaging content.

Please spare a moment to share yours.

Please select or type your specialty

  Thank you


Subscribe to get the best content related to lymphoma & CLL delivered to your inbox