Outcomes of second‐line axicabtagene ciloleucel for large B‐cell lymphoma in the UK

Journal article

Following approval of axicabtagene ciloleucel (axi‐cel) as second‐line (2 L) treatment for large B‐cell lymphoma (LBCL), results from real‐world CAR T cohorts will be key to confirm safety and efficacy in standard practice. We present comprehensive clinical outcomes of LBCL patients intended to be treated with 2 L axi‐cel through the UK National CAR T service. Of 345 patients approved for 2 L axi‐cel, 302 (87.5%) were infused. The median age was 62 years (range 22–78); 21% were over 70 years. 75% of patients were approved for CAR T within 3 months from end of first‐line (1 L) therapy. 42% of patients required pre‐apheresis holding therapy, and 97% received bridging therapy. The best overall response rate was 86% (64% complete response). The 12‐month OS was 73.9% (95% CI: 68.3–78.7) for infused patients and 1.5 months (0.9–3.0) for patients not proceeding to CAR T. The 12‐month PFS was 52.4% (46.3–58.0). In multivariable analysis, advanced stage, male sex, no response to 1 L therapy, high LDH, and high CRP pre‐infusion were independently associated with PFS. Grade ≥3 CRS and ICANS rates were 5% and 18%, respectively. Outcomes in patients aged ≥70 years were similar to the younger population. In this large UK real‐world cohort of 2 L axi‐cel in LBCL, we demonstrate efficacy and toxicity outcomes comparable to the pivotal ZUMA‐7 trial, despite 42% patients requiring urgent holding therapy. Outcomes were favorable in patients aged ≥70 years, supporting the use of 2 L CAR T in older fit patients.

Authors: Kuhnl, A; Kirkwood, AA; Northend, M; Besley, C; Uttenthal, B

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Wiley
• Journal: HemaSphere
• Volume: 10
• Issue: 2
• Article number: e70312
• Publication date: 2026-02-19
• Acceptance date: 2025-12-17
• DOI: 10.1002/hem3.70312
• EISSN: 2572-9241
• ISSN: 2572-9241
• Language: English