Award Title: Axicabtagene ciloleucel for treating diffuse large B-cell lymphoma and primary mediastinal B-cell lymphoma after 2 or more systemic therapies (Cancer Drugs Fund Review of TA559) [ID3980]
Funder: Department of Health and Social Care

Abstract: Lymphomas are cancers of the lymphatic system, which is a part of the immune system. Lymphomas are divided into Hodgkin lymphoma and non-Hodgkin lymphoma. Non-Hodgkin lymphomas (NHL) are a diverse group of conditions which are categorised according to the cell type affected (B-cell or T-cell), as well as the clinical features and rate of progression of the disease._x000D_
_x000D_
The most common B-cell lymphomas are follicular lymphoma (FL) which is a slow growing, low grade form of NHL and diffuse large B-cell lymphomas (DLBCL), a fast growing (‘aggressive’), high grade form of NHL. Some FL will transform into high grade DLBCL (transformed high grade FL). Primary mediastinal large B-cell lymphoma (PMBCL) is a rare type of NHL which develops in the mediastinum. The symptoms differ depending on what organ or tissues the lymphoma is affecting. NHL often presents as painless lumps (enlarged lymph nodes) in the neck, armpit or groin but sometimes may start in other parts of the body such as the stomach or bowel (extranodal disease). People may also have loss of appetite, tiredness or night sweats._x000D_
_x000D_
There were around 11,690 new cases of non-Hodgkin lymphoma (NHL) in England in 2015 with 6,322 of these DLBCL[1] . Approximately 3% of lymphomas in the UK are PMBC2L and 10-70% of low grade lymphomas transform into a high grade form[2],[3] Most people diagnosed with DLBCL are 65 or over[4] . 5-year survival rates for DLBCL are around 65-70% for stage 1 and 2 and around 50% at stages 3 and 4 [5] . _x000D_
_x000D_
The most widely used first-line treatment for DLBCL (including transformed follicular lymphoma and primary mediastinal (thymic) large B-cell lymphoma), is R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone). Sometimes etoposide is added to this regimen. NICE guideline NG52 recommends salvage therapy with rituximab in combination with chemotherapy for relapsed or refractory disease followed by stem cell transplantation. If stem cell transplantation is not suitable chemotherapy or immunotherapy may be used alone. NICE technology appraisal 306 recommends pixantrone monotherapy for people who have multiply relapsed, been treated previously with rituximab and are on the third or fourth line of treatment._x000D_
_x000D_
References_x000D_
1. Office for National Statistics. Cancer Registration Statistics, England, 2017. Office of National Statistics. Accessed January 2022._x000D_
2. Low grade NHL. Cancer research UK. Accessed November 2017._x000D_
3. Diffuse B-cell lymphoma. Lymphoma association. Accessed November 2017._x000D_
4. Survival for high grade lymphomas. Cancer Research UK. Accessed November 2017.

Lay Abstract: To appraise the clinical and cost effectiveness of axicabtagene ciloleucel within its marketing authorisation for treating relapsed or refractory diffuse large B-cell lymphoma and primary mediastinal large B-cell lymphoma after 2 or more lines of systemic therapy.

Research Activity Codes: 6.1 PHARMACEUTICALS
Health Categories: CANCER AND NEOPLASMS