Title: Axicabtagene ciloleucel for treating relapsed or refractory diffuse large B-cell lymphoma after 1 systemic therapy [ID1684]
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 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. The most common B-cell lymphomas are follicular lymphoma, a slow growing, low grade form of NHL, and diffuse large Bcell lymphoma (DLBCL), a fast growing, high grade form of NHL. Some follicular lymphomas transform into high grade DLBCL (transformed high grade follicular lymphoma). The symptoms differ depending on which organ or tissues are affected by the lymphoma. NHL often presents as painless lumps (enlarged lymph nodes) in the neck, armpit or groin but it can start in other parts of the body such as the stomach or bowel (extranodal disease). People may have loss of appetite, tiredness or night sweats._x000D_ _x000D_ There were around 12,065 people diagnosed with NHL in England in 2017.[1] It is estimated that about 40% of people with NHL have DLBCL,[2] which would equate to 4,826 registrations of DLBCL per year. _x000D_ _x000D_ Most people diagnosed with DLBCL are 65 or over.[3] Although most patients are cured with first-line chemotherapy, about 10-15% have primary refractory disease and a further 20-30% relapse.[4] Survival rates at 5 years for DLBCL are around 65- 70% for stage I and II and around 50% at stages III and IV (patients diagnosed between 2004 and 2011).[5]_x000D_ _x000D_ The most widely used first-line treatment for DLBCL is R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone). Sometimes etoposide is added to this regimen. For relapsed or refractory disease after 1 systemic therapy, NICE guideline NG52 recommends multi-agent chemotherapy, potentially in combination with rituximab, followed by stem cell transplantation for people who are fit enough to have it. Chemotherapy regimens commonly used in clinical practice include DHAP (dexamethasone, cytarabine, cisplatin), GDP (gemcitabine, dexamethasone, cisplatin), ICE (ifosfamide, carboplatin, etoposide) and IVE (ifosfamide, etoposide, epirubicin). If stem cell transplantation is not suitable, further chemotherapy or immunotherapy may be used alone. NICE TA649 recommends polatuzumab vedotin with rituximab and bendamustine for relapsed or refractory DLBCL in adults who cannot have stem cell transplantation._x000D_ _x000D_ References_x000D_ 1. Office for National Statistics. Cancer registration statistics, England. 2019. Accessed December 2021._x000D_ 2. Cancer Research UK. Diffuse large B cell lymphoma. Accessed December 2021._x000D_ 3. Lymphoma association. Diffuse B-cell lymphoma. Accessed December 2021._x000D_ 4. Chaganti S, Illidge T, Barrington S, McKay P, Linton K, Cwynarski K, et al. Guidelines for the management of diffuse large B-cell lymphoma. British journal of haematology. 2016;174(1):43-56. Available from: https://doi.org/10.1111/bjh.14136_x000D_ 5. Cancer Research UK. Non-Hodgkin lymphoma- Survival. Accessed December 2021.

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.

Research activity codes: 6.1 PHARMACEUTICALS
Health categories: CANCER AND NEOPLASMS