Tisagenlecleucel yields superior patient-reported health-related quality of life compared to autologous stem cell transplantation in patients with relapsed/refractory large B-cell lymphomas

TL;DR

CAR T-cell therapy improves patients' quality of life more than stem cell transplants for certain lymphomas, especially in the first year.

Contribution

This study provides novel evidence comparing long-term patient-reported quality of life outcomes between CAR T-cell therapy and stem cell transplantation for lymphoma.

Findings

CAR T-cell patients had significantly higher HRQoL scores at 12 months compared to HD-ASCT patients.

PROMIS-29 showed consistent advantages for CAR T-cell therapy across multiple domains.

Some quality of life benefits of CAR T-cell therapy were sustained at longer follow-up.

Abstract

Chimeric Antigen Receptor (CAR) T-cell therapy is an established treatment for relapsed or refractory large B-cell lymphoma (rr LBCL). While clinical efficacy is well documented, data on health-related quality of life (HRQoL) remain limited. This study assessed HRQoL in rr LBCL patients with long-term remission after CAR T-cell therapy versus high-dose chemotherapy with autologous stem cell transplantation (HD-ASCT). Twenty-eight consecutive rr LBCL patients in sustained remission were analyzed, with 15 receiving CAR T-cell therapy (tisagenlecleucel) and 13 undergoing HD-ASCT between 2019 and 2023. HRQoL was assessed using EQ-5D-5 L and PROMIS-29 questionnaires at 12 months and at a median of 36.8 months (range 15.7–57.2 months) post cellular therapy. Groups were compared for differences in HRQoL indices and domain scores. Median age was 63.5 (range 23–73) years. Twelve months post-treatment, CAR T-cell recipients reported significantly higher HRQoL scores than HD-ASCT patients (EQ-5D-5 L index value: 0.89 ± 0.11 vs. 0.72 ± 0.21; p = 0.015). Consistently, PROMIS-29 revealed clinically meaningful advantages in the CAR T-cell cohort across all seven categories. At later follow-up, EQ-5D-5 L index values converged (index-value 0.82 ± 0.22 vs. 0.7 ± 0.25; p = 0.2), whereas PROMIS-29 still indicated sustained benefit in five domains among CAR T-cell recipients. CAR T-cell therapy was associated with superior HRQoL in the first year compared to HD-ASCT. Although some differences diminished over time, CAR T-cell patients continued to experience better outcomes in several domains. These findings highlight clinical relevance of patient-reported outcome in rr LBCL, particularly in longitudinal surveys, and underscore the value of integrating patient-centered metrics into therapeutic decisions-making.

The online version contains supplementary material available at 10.1007/s00277-026-06840-5.

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