A new treatment era has begun for patients with relapsed or refractory large B-cell lymphoma (LBCL) following the FDA approval of the CAR T-cell therapies axicabtagene ciloleucel (Yescarta) and lisocabtagene maraleucel (Breyanzi). Both therapies have proven superior to the previous standard treatment of salvage chemotherapy followed by transplant.
In major clinical trials, axi-cel showed a median event-free survival of 8.3 months compared with 2.0 months using standard care but was linked with high rates of cytokine release syndrome and neurologic events. Liso-cel showed even better results, with median survival not reached and a much lower rate of severe side effects.
Real-world data confirmed these benefits even in older and sicker patients not eligible for the original trials. Axi-cel produced a 79% response rate and 71% one-year survival, while liso-cel achieved an 84% response rate and very low mortality. These results mark a significant advance, but treatment choice now depends on factors such as relapse timing, patient health, and tolerance for side effects.