Impact of TP53 mutations on survival outcomes in the CAR-T era of large B-cell lymphoma - PubMed

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TP53 mutations are strong adverse prognostic factors in large B-cell lymphoma (LBCL) treated with chemoimmunotherapy.
This study investigated if the adverse impact of TP53 mutations persists in the CAR-T therapy era, comparing outcomes between CAR-T and chemotherapy-based treatments.
Among TP53-mutated patients, CAR-T therapy led to significantly improved outcomes vs chemotherapy, with higher response rates (56.6% vs 18.2%) and longer median overall survival (12.13 vs 2.20 months).
In TP53 wild-type patients, CAR-T therapy also resulted in superior survival compared to chemotherapy (median OS 25.15 vs 8.28 months).
Within CAR-T-treated patients, TP53-mutated patients had similar response rates to wild-type but shorter median overall and progression-free survival.
CAR-T efficacy was consistent across TP53 mutation types, with non-DNA-binding domain mutations showing a trend toward further improved survival.
CAR-T-related toxicities were similar regardless of TP53 mutation status.
The adverse prognostic impact of TP53 mutations appears attenuated with CAR-T therapy, suggesting CAR-T may partially mitigate the negative effects of these mutations.

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