Enhancing Prediction of Long-Term Survival After CAR T in DLBCL
Key Clinical Summary
- In a single-center US cohort of 69 patients with diffuse large B-cell lymphoma (DLBCL) treated with standard-of-care CAR T, 33.3% achieved event-free survival at 12 months (EFS12).
- Baseline demographic and disease characteristics did not significantly differ between patients who achieved EFS12 and those who did not.
- Among EFS12 achievers, 5-year progression-free survival (PFS) was 68%, supporting EFS12 as a potential surrogate marker for long-term outcomes after CAR T therapy.
EFS12 may serve as a meaningful prognostic benchmark following CAR T therapy in DLBCL, according to a retrospective single-center study conducted at the University of Iowa. The findings build on prior data from ZUMA-1 and suggest that achieving EFS12 after CAR T is associated with durable remission and favorable long-term survival.
Study Findings
Investigators evaluated 69 patients with DLBCL treated with standard-of-care CAR T therapy. Most patients had advanced-stage disease (85.5%), a median International Prognostic Index (IPI) score of 3, and had received a median of 2 prior lines of therapy (63.8%). R-CHOP was the most common frontline regimen (62.3%), and 89.9% had not undergone prior autologous stem cell transplant. Axicabtagene ciloleucel (axi-cel) was the most frequently administered CAR T product (85.5%).
EFS12 was achieved by 23 patients (33.3%). No significant differences in demographic, clinical, or treatment characteristics were identified between the EFS12 and non-EFS12 groups (P > .05), indicating that baseline features did not distinguish those who reached the milestone.
At a median follow-up of 31.1 months, median PFS had not been reached among EFS12 achievers. Five-year PFS was 68%. Within this subgroup, 2 lymphoma-related deaths and 2 deaths related to prior therapy (myelodysplastic syndrome) were reported. Six patients experienced 2 or more infections, with a mean IgG level of 554.7 in the EFS12 population.
Clinical Implications
For hematologists managing relapsed or refractory DLBCL, the data suggest that EFS12 may function as an early surrogate marker for long-term survival after CAR T therapy. Established milestones such as EFS at 24 months after frontline chemoimmunotherapy and PFS at 24 months after autologous stem cell transplant have historically predicted overall survival in DLBCL. However, comparable benchmarks in the CAR T setting have been less clearly defined.
The absence of distinguishing baseline clinical factors among EFS12 achievers underscores the challenge of predicting long-term benefit prior to treatment. Nevertheless, patients who remain event-free at 12 months appear to have durable remissions and favorable 5-year outcomes. If validated in larger cohorts, EFS12 could provide clinicians and patients with a practical early indicator of long-term prognosis after CAR T.
The investigators concluded that “patients with DLBCL who achieved EFS12 post-CAR-T represented one-third of the cohort and shared similar baseline characteristics with the overall population.” Despite the lack of predictive baseline factors, this subgroup demonstrated “favorable long-term outcomes,” highlighting the prognostic value of reaching the EFS12 milestone.
Conclusion
In this US single-center analysis, one-third of patients with DLBCL treated with CAR-T achieved EFS12, and these patients demonstrated sustained remission and 68% 5-year PFS. The findings support EFS12 as a potential surrogate marker for long-term outcomes in the CAR T setting.
Reference
Ravindra A, Loeffler BT, Strouse CS, Farooq U. Event-free survival at 12 months predicts long-term outcomes in DLBCL patients receiving CAR-T therapy. Transplant Cell Ther. 2026; 32(2): S382-S383. doi:10.1016/j.jtct.2025.12.550
