# Early relapse: CAR-T before transplant

Source: https://onco.cc/pairings/car-t-before-transplant-lbcl/  
OnCo record `car-t-before-transplant-lbcl` (Pairing). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

If large B-cell lymphoma comes back within a year, CAR-T should come before, not after, a transplant attempt.

## Summary

This sequence rule says that when large B-cell lymphoma relapses within a year of first-line treatment, CAR-T cell therapy should be given before, not after, an attempt at high-dose therapy and autologous stem cell transplant. Chemorefractory disease rarely gets as far as transplant because it must first respond to salvage chemotherapy, whereas CAR-T does not require chemosensitivity. Two positive phase 3 trials, ZUMA-7 with axi-cel and TRANSFORM with liso-cel, showed better event-free survival for CAR-T than salvage chemotherapy plus transplant, and ZUMA-7 also showed an overall survival benefit; the negative BELINDA trial is explained by its design. Transplant remains the option for late relapses that respond to salvage.

## Fields

- Kind: Pairing
- Last checked: 2026-09-07
- Pairs: CAR-T cell therapy + Autologous stem cell transplant (high-dose therapy)
- Type: sequence
- Rationale: Chemorefractory disease rarely reaches transplant (36% in ZUMA-7 control arm); CAR-T does not require chemosensitivity.
- Evidence: Two positive phase 3 trials; one negative (BELINDA) explained by design.

## Sources

- ClinicalTrials.gov NCT03391466: ZUMA-7: https://clinicaltrials.gov/study/NCT03391466
- ClinicalTrials.gov NCT03575351: TRANSFORM: https://clinicaltrials.gov/study/NCT03575351

## Connected records

- cancers: [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/)
- trials: [BELINDA](https://onco.cc/trials/belinda/), [TRANSFORM](https://onco.cc/trials/transform/), [ZUMA-7](https://onco.cc/trials/zuma-7/)
- technologies: [Autologous stem cell transplant (high-dose therapy)](https://onco.cc/technologies/autologous-stem-cell-transplant/), [CAR-T cell therapy](https://onco.cc/technologies/car-t/)
- key papers: [TRANSFORM: liso-cel CAR-T versus salvage chemotherapy and transplant in early-relapsing large B-cell lymphoma](https://onco.cc/key-papers/paper-transform-liso-cel-lancet-2022/), [ZUMA-7: axi-cel CAR-T instead of salvage chemotherapy and transplant for large B-cell lymphoma that relapses early](https://onco.cc/key-papers/paper-zuma-7-axi-cel-second-line-nejm-2022/)

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