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

[BACKGROUND] Relapsed/refractory (R/R) follicular lymphoma (FL) often requires multiple lines of therapy.

[OBJECTIVE] 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.

[METHODS] 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.

[RESULTS] 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;  < 0.0001)and 4L+ (CR 0.26; 95% CI 0.16-0.42;  < 0.0001), and post-CAR T medical costs at 4L+ (CR 0.69; 95% CI 0.51-0.94;  = 0.017).

[CONCLUSIONS] 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.