Blood cancers

After CAR T-cell therapy, quality of life is good for people with RR DLBCL

The value of CAR T-cell therapy in refractory or relapsed diffuse large B cell lymphoma (RR DLBCL) has been further boosted by a study showing the salvage therapy also leads to better physical and social function in addition to its impressive survival outcomes in patients with advanced disease.

In a post hoc analysis of patient-reported outcomes (PROs) in the JULIET trial researchers in the US and Australia evaluated quality of life in adult patients with RR DLBCL undergoing treatment with the CAR T-cell therapy, tisagenlecleucel.

The study is one of the few to look at quality of life related to CAR T-cell products more than 1 year from treatment, say the authors.

Speaking to the limbic Dr Constantine Tam, Director of haematology at the Peter MacCallum Centre and an investigator on the study, says because CAR-T offers a potentially ‘curative’ therapy it is becoming increasingly important to understand not just how long someone survives after receiving therapy for advanced disease but how well.

“In this study we showed there was a high – 40% – complete remission rate for patients who got CAR-T cells. These are patients who had either failed or are ineligible for transplant that otherwise, frankly, are destined to die,” he told the limbic.

The therapy provides a ‘curative option’ where previously none were available, he adds.

“But of course CAR-T cell therapy is complicated and expensive and a key question is: sure patients are surviving their lymphoma – but are they deriving a quality of life benefit from this? Are they able to get back to a normal quality of life?”

Patients were asked to report on their quality of life using two tools. The FACT-Lym score assessed physical, social, emotional, and functional well-being as well as disease- and treatment-related symptoms. The SF-36 Survey elicited responses related to physical and social function, health perception, and mental health.

Some 99 patients of the 115 involved in the JULIET trial were eligible for subsequent HRQoL evaluation including 57 patients who achieved either a complete or partial response to therapy.

Data were collected prior to treatment and at three, six, 12, and 18 months post treatment with 30 patients completing the 12-month follow-up questionnaire and 21 patients provided 18-month follow-up responses.

The analysis showed that patients with a complete or partial response to therapy exhibited sustained health-related QoL improvements in all FACT-Lym scores at each follow-up assessment.

The largest improvements from baseline related to functional, physical, and social/family domains at 18-month follow-up, with the largest mean change from baseline in the emotional domain occurring at 12-month follow-up.

Researchers also observed improvement in general health, vitality, physical functioning, role-physical and social functioning that exceeded minimal clinically important differences.

“The key message is if you actually had a response to CAR-T cells you’ve got a quality of life that is really quite good and markedly superior to when you had lymphoma,” says Dr Tam.

That may be a self-evident observation, he says, but one that is important to measure.

“These patients can get back to a normal quality of life and we can now inform our patients that if they get CAR-T cells and are successful in achieving remission the treatment does not cause long term disabling side effects that impair quality of life for the majority of patients,” he said

But while scores revolving around social and physical functioning – intimacy, interactions with family and friends, ability to work, and ability to enjoy activities – all showed improvement, there was little change in emotional and mental health scores from baseline to three months.

“There is increasing recognition that one of the major survivorship issues in lymphoma is anxiety and depression and certainly good psychosocial teams who are actively supporting patients in the critical phase of the illness post treatment will be important,” Dr Tam added.

The study can be found here in Blood Advances.

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