Real-world outcomes after CAR T versus standard therapy in third-line or later relapsed or refractory follicular lymphoma in the United States

Relapsed/refractory (R/R) follicular lymphoma (FL) often requires multiple lines of therapy. To compare time to next treatment (TTNT), treatment-free interval (TFI), healthcare resource utilization (HRU), and downstream costs among R/R FL patients treated with CAR T versus non-CAR T therapy. Adult R/R FL patients with ≥2 prior lines of therapy were stratified into CAR T and non-CAR T cohorts. The Index Date was CAR T infusion (CAR T) or 3L initiation (non-CAR T). Outcomes included TTNT, TFI, HRU, and costs. Analyses were descriptive, incorporating Kaplan-Meier methods and multivariable models. 335 CAR T and 4,342 non-CAR T patients were included. Median TTNT was not reached for CAR T, with longer TFIs observed in descriptive analyses. Adjusted analyses showed lower pharmacy costs at both 3L+ (CR 0.32; 95% CI 0.21–0.48; p < 0.0001)and 4L+ (CR 0.26; 95% CI 0.16–0.42; p < 0.0001), and post-CAR T medical costs at 4L+ (CR 0.69; 95% CI 0.51–0.94; p = 0.017). In this real-world analysis, CAR T was associated with longer TTNT, longer TFI, and lower downstream FL-related costs compared with non-CAR T therapy, with interpretation informed by differences in follow-up time and treatment context. Follicular lymphoma (FL) is a type of blood cancer that often returns after treatment. As a result, many patients receive several different treatments over time. Chimeric antigen receptor T-cell therapy (CAR T) is a newer treatment option for FL that can be used after at least two prior treatments have stopped working. This study used health insurance records to compare what happened to patients who received CAR T with patients who received other standard treatments in later stages of the disease. We looked at how long patients went without needing another treatment, how often they used healthcare services, and the costs of care after treatment. Patients who received CAR T generally went longer without needing additional treatment and had lower FL-related treatment costs after CAR T therapy compared with patients receiving other treatments. As this study looked at existing claims records than assigning treatments, the two patient groups were not exactly the same and were followed for different lengths of time. For this reason, results should be interpreted as showing overall trends rather than definitive comparisons.