Is CAR T-cell Therapy More Effective for Transformed Follicular Lymphoma or De Novo DLBCL?

This article shares new research about how individuals whose follicular lymphoma has transformed into diffuse large B-cell lymphoma (DLBCL) respond to CAR T-cell therapy. You’ll learn how outcomes compare to those with DLBCL that didn’t start as follicular lymphoma and what factors may influence treatment success. 

People with transformed follicular lymphoma had better responses to treatment

Two studies presented at the ASH conference looked at people who received CAR T-cell therapy, a treatment that uses a person’s own immune cells to fight cancer, after their follicular lymphoma transformed into DLBCL.

In the first study, Dr. Matthew Cortese and researchers reviewed real-world data from 691 people who received CAR-T:

• 552 people had DLBCL that developed on its own (called de novo DLBCL)
• 139 people had DLBCL that transformed from follicular lymphoma

Six months after treatment:

• 52% of people with transformed lymphoma had reduced signs of cancer, compared to 36% of those with de novo DLBCL.
• Cancer was undetectable in 45% of people with transformed lymphoma versus 31% with de novo DLBCL.
• Relapse occurred in 40% of the transformed group compared to 56% in the de novo group.

These findings matter because they show that people with transformed follicular lymphoma often responded better to CAR-T than those with de novo DLBCL. This information can help you understand how the DLBCL type may affect treatment success. 

Long-term outcomes were also better for transformed follicular lymphoma

Researchers continued tracking these individuals over time. Three years after treatment, 54% of people with transformed follicular lymphoma were alive without signs of cancer progression. In contrast, 39% of those with de novo DLBCL had the same result. 

Even those with harder-to-treat lymphoma, such as individuals who had no response to their last treatment (primary refractory) or relapsed early, did better if their cancer had transformed from follicular lymphoma. This helps people with transformed lymphoma understand that CAR-T can offer meaningful long-term benefits. 

Risk factors that may affect your outcome

In a second study, Dr. Swetha Kambhampati Thiruvengadam and colleagues analyzed outcomes for people with transformed indolent lymphoma (including follicular lymphoma) and compared them to people with de novo DLBCL. 

What they found:

• Complete remission was achieved by 67% of people with transformed lymphoma and 59% with de novo DLBCL.
• After adjusting for other variables (such as age, stage, and previous treatments), those with transformed lymphoma had a 16% lower risk of cancer coming back or progressing, or of death.

Several factors were tied to poorer outcomes after CAR T-cell therapy:

• High levels of lactate dehydrogenase (LDH), which can signal cell damage
• Advanced-stage cancer
• Having more than three prior therapies
• Use of bendamustine within the past year
• Cancer in the brain or spinal cord (CNS involvement)
• Requiring bridging therapy, a short-term treatment before CAR-T to reduce cancer cells and symptoms

Understanding these risks can help you and your care team see how they relate to your medical history. This can guide more informed treatment decisions and may improve your outcomes. 

Talk with your doctor about these findings

If your follicular lymphoma has transformed into DLBCL, these study results may help inform your treatment path. People in this situation often responded better to CAR T-cell therapy than individuals with de novo DLBCL. Understanding your treatment history and individual risk factors can help you and your DLBCL specialist build the most effective care plan. 

Because transformed follicular lymphoma patients are often not included in clinical trials, research like this using real-world data is especially valuable. If you want to contribute to research and help improve care, you can participate in real-world data surveys in HealthTree Cure Hub®. 

Learn how you can contribute to real-world research

Sources: 

• Clinical Outcomes of Transformed Follicular Lymphoma with CAR T-Cell Therapy: A US Multicenter Real-World Analysis
• Real-World Outcomes of CD19CAR T Cell Therapy in Adult Patients with Relapsed Refractory Transformed Indolent Lymphoma