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CLL-1357: Real-World Comparison of Axi-Cel and Liso-Cel in Richter Transformation
Abstract   Peer reviewed

CLL-1357: Real-World Comparison of Axi-Cel and Liso-Cel in Richter Transformation

Faiza Khan, Ali Mohsin, Hasan Ilyas, Muhammad Furqan, Zunaira Amjad, Muhammad Usman Haider, Ishtiaq Ahmad, Ghulam Mustafa, Muhammad Tayyab Tahir and Haider Bin Khalid
Clinical lymphoma, myeloma and leukemia, Vol.26(Suppl 1), pp.S643-S643
08/2026
DOI: 10.1016/S2152-2650(26)02106-3

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Abstract

Background: RT of CLL/small lymphocytic lymphoma (CLL/SLL) to DLBCL is associated with poor outcomes and limited treatment options. Anti-CD19 CAR-T therapy has shown promising activity in RT; however, comparative real-world data between CAR-T products remains limited. We compared the efficacy and safety of axicabtagene ciloleucel (axi-cel) and lisocabtagene maraleucel (lisocel) in patients with RT. Methods: Using the TriNetX Global Collaborative Network, we identified adults with RT defined as sequential ICD-10 diagnoses of CLL/SLL (C91.1, C83.0) followed by DLBCL (C83.3) between January 1, 2018, and December 31, 2025, who subsequently received axi-cel (n = 124) or liso-cel (n = 109). The index date was the CAR-T infusion. Propensity score matching (1:1) was performed for age, sex, race, prior chemotherapy exposure, and prior treatment with BTK inhibitors and venetoclax. Outcomes included composite mortality/hospice utilization at 1, 3, and 5 years and CRS and cytopenias at 30 and 90 days. Kaplan-Meier analyses, log-rank testing, and hazard ratios (HRs) were used for time-to-event analyses. Results: After matching, 65 patients were included in each cohort with balanced baseline characteristics. Median age was 66 years, with predominantly male and White patients. One-year mortality was 33.3% vs 30.0% (HR, 0.89; 95% CI, 0.47–1.69; P = 0.58), while 5-year mortality was 61.7% vs 47.8% (HR, 0.85; 95% CI, 0.46–1.57; P = 0.40). Composite mortality/hospice utilization was comparable at 1 year (26.6% vs 29.7%; HR, 0.78; 95% CI, 0.40–1.50; P = 0.09), 3 years (HR, 0.75; 95% CI, 0.41–1.38; P = 0.36), and 5 years (HR, 0.85; 95% CI, 0.46–1.57; P = 0.40). CRS rates were similar at 30 days (36.7%/41.7%; HR, 0.82; 95% CI, 0.46–1.46; P = 0.76) and 90 days (35.5%/45.2%; HR, 0.67; 95% CI, 0.38–1.17; P = 0.21). Neutropenia/thrombocytopenia/anemia at 30 days were 42.2%/48.4% (HR, 0.82; CI, 0.49–1.38; P = 0.77), 20.3%/34.4% (HR, 0.56; CI, 0.28–1.104; P = 0.11), and 21.9%/18.8% (HR, 1.15; CI, 0.53–2.49; P = 0.74); at 90 days, 50.0%/56.3% (HR, 0.81; CI, 0.51–1.31; P = 0.85), 31.3%/42.2% (HR, 0.67; CI, 0.38–1.19; P = 0.52), and 28.1%/29.7% (HR, 0.90; CI, 0.47–1.71; P = 0.47). Conclusion: In this real-world RT cohort, axi-cel and liso-cel demonstrated comparable survival outcomes, hospice utilization, and toxicity profiles. These findings provide comparative evidence supporting the clinical utility of both products in this high-risk disease setting. CAR-T: chimeric antigen receptor T-cell, CD: cluster of differentiation, CI: confidence interval, CLL: chronic lymphocytic leukemia, CRS: cytokine release syndrome, DLBCL: diffuse large B-cell lymphoma, HR: hazard ratio, ICD-10: International Classification of Diseases, Tenth Revision, RT: Richter transformation.
 axicabtagene ciloleucel CAR-T therapy chronic lymphocytic leukemia CLL diffuse large B-cell lymphoma lisocabtagene maraleucel Richter transformation

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