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Patient selection and treatment outcomes over time in patients with large B-cell lymphoma receiving car T-cell therapy

Bone Marrow Transplantation (2025)Cite this article

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CAR T-cell therapy has substantially improved outcomes for patients with relapsed or refractory (r/r) large B-cell lymphoma (LBCL), especially following failure of standard chemo-immunotherapy. The clinical use of axicabtagene ciloleucel (axi-cel), tisagenlecleucel (tisa-cel), and lisocabtagene maraleucel has led to increased access and broader application in real-world settings [1,2,3,4,5]. With this expansion, observational studies have identified important prognostic factors—such as ECOG performance status, tumor burden, lactate dehydrogenase (LDH) levels, and inflammatory biomarkers—that help refine patient selection and risk stratification [6,7,8,9,10]. Moreover, growing experience has enhanced management strategies for common toxicities, such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), resulting in fewer severe cases compared to initial clinical trials.

Despite these improvements, it remains uncertain whether outcomes have improved over time as a result of clinical experience. While some studies suggest enhanced survival and lower toxicity rates in later treatment cohorts [11], this has not been universally confirmed. The present study evaluates temporal trends in outcomes for CAR T-cell therapy in Spain and investigates the potential influence of a clinical learning curve on efficacy and safety metrics. This study was approved by the Hospital Germans Trias i Pujol ethic committee (PIU-23-052) and all methods were performed in accordance with the relevant guidelines and regulations. An informed consent was obtained from all participants.

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Fig. 1: Survival outcomes for the study cohort.

Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. ICO-Hospital Germans Trias i Pujol, Institut de Recerca contra la Leucèmia Josep Carreras (IJC), Badalona, Spain

    Anna Torrent, Mireia Morgades & Juan-Manuel Sancho

  2. Universitat Autònoma de Barcelona, Barcelona, Spain

    Anna Torrent, Mireia Morgades & Juan-Manuel Sancho

  3. Hospital Universitari Vall d’Hebron. Universitat Autónoma de Barcelona, Barcelona, Spain

    Gloria Iacoboni, Cecilia Carpio & Pere Barba

  4. University Hospital Virgen Del Rocío, Sevilla, Spain

    Juan Luis Reguera

  5. Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain

    Mi Kwon & Javier Delgado

  6. Hospital Universitario de Salamanca, IBSAL, CIBERONC, Universidad de Salamanca, Salamanca, Spain

    Lucia López Corral & Alejandro Martin Garcia-Sancho

  7. Hospital Clínico de Valencia, Valencia, Spain

    Rafael Hernani

  8. Hospital Clinic de Barcelona, Barcelona, Spain

    Valentín Ortiz-Maldonado

  9. Departament de Medicina Universitat de Valencia, CIBERONC, Hospital Universitari i Politècnic La Fe, Instituto Carlos III, Madrid, Spain

    Jaime Sanz

  10. Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

    Ana Carolina Caballero Gonzalez

  11. Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain

    Luisa Guerra

  12. Hospital Universitario 12 de Octubre, Madrid, Spain

    José María Sánchez Pina

  13. Institut Català d’Oncologia-Hospitalet, IDIBELL, Barcelona, Spain

    Alberto Mussetti

  14. Hospital General Gregorio Marañón, Madrid, Spain

    Mariana Bastos-Oreiro

  15. Pediatric Hemato-Oncology Department, La Paz University Hospital, Madrid, Spain

    Antonio Pérez-Martinez

Authors
  1. Anna Torrent
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  2. Mireia Morgades
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  3. Gloria Iacoboni
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  5. Mi Kwon
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  6. Lucia López Corral
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  8. Valentín Ortiz-Maldonado
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  9. Jaime Sanz
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  10. Ana Carolina Caballero Gonzalez
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  11. Luisa Guerra
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  16. Javier Delgado
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  17. Cecilia Carpio
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  19. Antonio Pérez-Martinez
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  20. Pere Barba
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Contributions

AT: Investigation (equal), visualization (equal), validation (equal), writing—original draft preparation (lead), writing—review and editing (equal). MM: Data curation (lead), formal analysis (lead). PB: Conceptualization (lead), Investigation (equal), visualization (equal), Methodology (lead), Project administration (lead), supervision (lead), validation (equal), writing and review and editing (equal). GI, JLR, MK, LLC, RH, VOM, JS, ACCG, LG, JMSP, AM, AMGS, MBO, JD, CC, JMS, and APM contributed to the review and editing of the manuscript (equal).

Corresponding author

Correspondence to Anna Torrent.

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Competing interests

- Anna Torrent: Advisory Board fees from Amgen, Incyte. Honoraria from Kite/Gilead, Incyte, Pfizer, Amgen, Servier, and SERB. Gloria Iacoboni: Consultancy and Honoraria from Novartis, Roche, Kite/Gilead, Bristol-Myers Squibb, Abbvie, Janssen, Sandoz, Miltenyi, and AstraZeneca. Alejandro Martin García-Sancho: Honoraria and/or consulting fees: Abbvie, AstraZeneca, BeiGene, BMS, Genmab, Gilead/Kite, GSK, Ideogen, Incyte, Janssen, Kyowa Kirin, Lilly, Miltenyi, Regeneron, Roche, Sobi, Takeda. Research support: Gilead/Kite. Cecilia Carpio: Consultancy/Advisory from Regeneron, BMS, Takeda. Honoraria from Takeda, Janssen, and Novartis. Consultancy from Novotech. Pere Barba: Advisory Board and consultancy from Allogene, Amgen, Autolus, BMS/Celgene, Kite/Gilead, Incyte, Miltenyi Biomedicine, Novartis, Nektar, Pfizer and Pierre Fabre. For the remaining authors, no relevant conflicts of interest were declared.

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Torrent, A., Morgades, M., Iacoboni, G. et al. Patient selection and treatment outcomes over time in patients with large B-cell lymphoma receiving car T-cell therapy. Bone Marrow Transplant (2025). https://doi.org/10.1038/s41409-025-02722-y

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  • DOI: https://doi.org/10.1038/s41409-025-02722-y

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