Locally manufactured versus commercial CAR T therapy for large B-cell lymphoma : a multi-center propensity score-matched analysis.

Locally manufactured chimeric antigen receptor T-cell (CAR T) therapy enables rapid manufacturing and a substantially shorter vein-to-vein time. However, its clinical efficacy compared to commercial CAR T products remains unclear. This retrospective study compared outcomes in patients with Large B-cell lymphoma (LBCL) treated with a CD19-directed autologous locally manufactured CAR T product (CD28-based co-stimulation) versus axicabtagene-ciloleucel (axi-cel) or tisagenlecleucel (tisa-cel) across three academic centers. All patients had received at least two prior lines of therapy. Propensity score analysis for CAR T product adjusted for age, karnofsky performance status, lactate dehydrogenase (LDH) level, primary refractory disease, and transformed histology were performed to account for underlying differences in treatment groups. Among 330 patients (132 axi-cel, 104 tisa-cel, 94 locally manufactured), those treated with locally manufactured CAR T were younger, had higher performance status, and were more likely to present with elevated LDH and primary refractory disease. Median time from apheresis to CAR T infusion was significantly shorter with locally manufactured CAR T (11 days) than with axi-cel (38 days) or tisa-cel (44 days) (p.