Early relapse: CAR-T before transplant
If large B-cell lymphoma comes back within a year, CAR-T should come before, not after, a transplant attempt.
ZUMA-7 and TRANSFORM: CAR-T beats salvage chemotherapy plus transplant on EFS, and ZUMA-7 on OS; transplant remains for late relapses that respond to salvage.
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.
ZUMA-7 rewrote second-line treatment for aggressive lymphoma: patients whose disease returns within a year of R-CHOP should be offered CAR-T rather than salvage chemotherapy and transplant. It is also one of the few cell-therapy trials to show an overall survival benefit despite crossover. Patients relapsing later than 12 months were not studied and transplant remains standard for them if chemosensitive.