CAR T in Practice: Translating ZUMA-7 Trial Data for Axi-Cel in Second-Line Treatment Decisions

One of the most impactful developments in the treatment of primary refractory diffuse large B-cell lymphoma has been the results of the ZUMA-7 trial. This landmark study remains the only randomized chimeric antigen receptor (CAR) T-cell therapy trial to show an overall survival benefit compared to standard of care. While other CAR T products are also effective, the strength of this trial lies in its robust design and clear demonstration that these therapies do more than provide a novel option—they can actually save lives and may offer a curative potential for some patients. The ZUMA-7 data are mature, with nearly 4 years of follow-up supporting the long-term benefit of second-line CAR T therapy.

An important insight from this trial was the observation that patients who initially received standard chemotherapy with the intention of proceeding to transplant but later relapsed and went on to receive CAR T in the third line had worse outcomes than those who received it earlier. This highlights the importance of early intervention; delaying CAR T until later lines of therapy can significantly reduce its effectiveness. The study reinforces the idea that if a patient is eligible, it is best to pursue CAR T as the second-line option, rather than exhausting traditional chemotherapy first.

Another key takeaway from the trial was the difference in recovery trajectory between patients receiving CAR T and those undergoing high-dose chemotherapy and autologous transplant. Patients in the CAR T arm were able to return to their baseline quality of life more quickly. The treatment process was shorter and less physically taxing, allowing for faster functional recovery. These real-world outcomes—improved survival, reduced disease burden, and quicker return to normal life—make a strong case for considering CAR T therapy not just as a salvage option, but as a preferred second-line treatment for eligible patients.