{"entity":{"id":"car-t-before-transplant-lbcl","kind":"pairing","name":"Early relapse: CAR-T before transplant","aka":[],"tldr":"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.","asOf":"2026-09-07","links":[{"label":"ClinicalTrials.gov NCT03391466: ZUMA-7","url":"https://clinicaltrials.gov/study/NCT03391466"},{"label":"ClinicalTrials.gov NCT03575351: TRANSFORM","url":"https://clinicaltrials.gov/study/NCT03575351"}],"tags":[],"related":[],"cancers":["dlbcl"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["zuma-7","transform","belinda"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"a":"car-t","b":"autologous-stem-cell-transplant","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.","pairingType":"sequence"},"route":"/pairings/car-t-before-transplant-lbcl/","neighbours":{"cancer":[{"id":"dlbcl","kind":"cancer","name":"Diffuse large B-cell lymphoma","route":"/cancers/dlbcl/"}],"trial":[{"id":"belinda","kind":"trial","name":"BELINDA","route":"/trials/belinda/"},{"id":"transform","kind":"trial","name":"TRANSFORM","route":"/trials/transform/"},{"id":"zuma-7","kind":"trial","name":"ZUMA-7","route":"/trials/zuma-7/"}],"technology":[{"id":"autologous-stem-cell-transplant","kind":"technology","name":"Autologous stem cell transplant (high-dose therapy)","route":"/technologies/autologous-stem-cell-transplant/"},{"id":"car-t","kind":"technology","name":"CAR-T cell therapy","route":"/technologies/car-t/"}],"paper":[{"id":"paper-transform-liso-cel-lancet-2022","kind":"paper","name":"TRANSFORM: liso-cel CAR-T versus salvage chemotherapy and transplant in early-relapsing large B-cell lymphoma","route":"/key-papers/paper-transform-liso-cel-lancet-2022/"},{"id":"paper-zuma-7-axi-cel-second-line-nejm-2022","kind":"paper","name":"ZUMA-7: axi-cel CAR-T instead of salvage chemotherapy and transplant for large B-cell lymphoma that relapses early","route":"/key-papers/paper-zuma-7-axi-cel-second-line-nejm-2022/"}]}}