Date of Award


Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)


Physician Assistant Studies

First Advisor

Kauffman, Russell


Diffuse large B cell lymphoma is the most common and aggressive subset of non-Hodgkin lymphoma. Approximately 20-50% of patients will either relapse or become refractory to primary chemoimmunotherapy treatment methods and require second line treatment, which consists of aggressive high dose chemotherapy and autologous stem cell transplantation (ASCT). Chimeric antigen T cell receptor (CAR-T) therapy is a novel treatment strategy consisting of autologously derived genetically engineered T cells that has been tested as an alternative method for treatment of aggressive forms of DLBCL. The purpose of this review is to compare the efficacy, safety, and cost effectiveness of standard of care treatment versus CAR-T therapy for utility against relapsed and refractory DLBCL. A systematic literature review was performed which evaluated 10 articles identified by specific search criteria. Primary endpoints evaluated include event-free and overall survival, response rates, patient tolerance, and cost. Overall, this review found CAR-T to be superior to standard of care therapy on multiple accounts. Combined data demonstrate a six month increase in event-free survival with CAR-T vs standard of care therapy as well as dramatically increased overall survival. Response rates among patients who received CAR-T were also greatly increased compared to those who received standard of care. Although CAR-T was associated with increased rates of neurological events and cytokine release syndrome that was not observed in standard therapy, the frequency of grade 3 events was similar between treatments. Moreover, patient quality of life scores were higher from those who received CAR-T, suggesting that adverse events alone did not contribute to increased patient distress. Finally, although overall cost of CAR-T exceeded that of standard of care treatment, the incremental survival benefits and quality of life superseded cost alone. Based on these data, the conclusion can be drawn that CAR-T is superior to that of standard of care. Notably, during the writing of this review CAR-T was approved as the preferred second-line treatment method for relapsed or refractory DLBCL.