# TRANSFORM: liso-cel CAR-T versus salvage chemotherapy and transplant in early-relapsing large B-cell lymphoma

Source: https://onco.cc/key-papers/paper-transform-liso-cel-lancet-2022/  
OnCo record `paper-transform-liso-cel-lancet-2022` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

In TRANSFORM, a second CD19 CAR-T, lisocabtagene maraleucel, also beat chemotherapy-plus-transplant as second-line treatment, with a low rate of severe side effects.

## Summary

TRANSFORM randomised 184 patients with large B-cell lymphoma refractory to or relapsed within 12 months of first-line therapy to lisocabtagene maraleucel (liso-cel) or standard salvage chemotherapy with autologous transplant for responders. Bridging chemotherapy was allowed and crossover to liso-cel was permitted for standard-arm failures. The primary endpoint was event-free survival. At the interim analysis median EFS was 10.1 versus 2.3 months (hazard ratio 0.35) with complete response 66% versus 39%; in the primary analysis median EFS was not reached versus 2.4 months (hazard ratio 0.36). Grade 3 CRS occurred in 1% and grade 3 neurological events in 4%. Overall survival was not significantly different, in part because of crossover.

## Fields

- Kind: Key paper
- Last checked: 2026-09-08
- Journal: The Lancet
- Year: 2022
- DOI: 10.1016/S0140-6736(22)00662-6
- Authors: Kamdar M, Solomon SR, Arnason J, et al.
- Findings: 184 patients with primary refractory or early-relapsing LBCL; liso-cel vs salvage chemotherapy and transplant.; Interim: median EFS 10.1 vs 2.3 months; hazard ratio 0.35; complete response 66% vs 39%.; Primary analysis: median EFS not reached vs 2.4 months; hazard ratio 0.36.; Grade 3 CRS 1%; grade 3 neurological events 4%; no grade 4-5 CRS or neurotoxicity.; Crossover to liso-cel allowed; OS not significantly different.
- What it means: TRANSFORM confirmed ZUMA-7's conclusion with a different CD19 CAR-T and a more permissive design that allowed bridging chemotherapy, making the results closer to real-world practice. Liso-cel's low toxicity makes it attractive for older or frailer patients and for outpatient delivery. Together the two trials made CAR-T the standard second-line therapy for early-relapsing aggressive lymphoma.
- Caveats: Smaller than ZUMA-7 and reported at interim analysis; EFS rather than OS was the endpoint.; Crossover blunted any survival comparison.; Excludes late relapse.; Liso-cel manufacturing involves separate CD4 and CD8 components, adding complexity.

## Sources

- PubMed search: https://pubmed.ncbi.nlm.nih.gov/?term=TRANSFORM%20lisocabtagene%20maraleucel%20second-line%20Kamdar%20Lancet%202022
- ClinicalTrials.gov NCT03575351: https://clinicaltrials.gov/study/NCT03575351

## Connected records

- pairings: [Early relapse: CAR-T before transplant](https://onco.cc/pairings/car-t-before-transplant-lbcl/)
- key papers: [Lisocabtagene maraleucel for patients with relapsed or refractory large B-cell lymphomas (TRANSCEND NHL 001): a multicentre seamless design study](https://onco.cc/key-papers/paper-transcend-nhl-001-liso-cel-lancet-2020/), [Second-line tisagenlecleucel or standard care in aggressive B-cell lymphoma](https://onco.cc/key-papers/paper-belinda-tisagenlecleucel-second-line-nejm-2022/), [ZUMA-7: axi-cel CAR-T instead of salvage chemotherapy and transplant for large B-cell lymphoma that relapses early](https://onco.cc/key-papers/paper-zuma-7-axi-cel-second-line-nejm-2022/)
- roadmaps: [Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting](https://onco.cc/roadmaps/lymphoma-roadmap/)
- cancers: [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/)
- technologies: [Autologous stem cell transplant (high-dose therapy)](https://onco.cc/technologies/autologous-stem-cell-transplant/), [CAR-T cell therapy](https://onco.cc/technologies/car-t/)
- targets: [CD19](https://onco.cc/targets/cd19/)
- drugs: [Lisocabtagene maraleucel](https://onco.cc/drugs/lisocabtagene-maraleucel/)
- companies: [Bristol Myers Squibb](https://onco.cc/companies/bms/)
- terms: [Cytokine release syndrome (CRS)](https://onco.cc/terms/crs/), [Event-free / disease-free survival (EFS, DFS, iDFS, RFS)](https://onco.cc/terms/efs/), [ICANS (neurotoxicity)](https://onco.cc/terms/icans/)
- trials: [BELINDA](https://onco.cc/trials/belinda/), [TRANSFORM](https://onco.cc/trials/transform/), [ZUMA-7](https://onco.cc/trials/zuma-7/)
- bottlenecks: [Manufacturing cost and time for living and radioactive medicines](https://onco.cc/bottlenecks/b-manufacturing-cell-therapy/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- journals: [The Lancet](https://onco.cc/journals/lancet/)

---
JSON: https://onco.cc/api/v1/entities/paper-transform-liso-cel-lancet-2022.json