Indirect Comparison Supports Favorable Outcomes With Liso-cel in Relapsed or Refractory Follicular Lymphoma
A new matching-adjusted indirect comparison published in Experimental Hematology & Oncology offers a head-to-head analysis of 2 advanced treatment options for relapsed or refractory (R/R) follicular lymphoma (FL): lisocabtagene maraleucel (liso-cel), a CD19-directed CAR T-cell therapy, and mosunetuzumab, a CD20 × CD3 bispecific antibody. Although no prospective, randomized trials directly compare these agents, researchers used individual patient data from the TRANSCEND FL trial and published summary data from the GO29781 study to assess comparative efficacy and safety in the third-line or later (3L+) setting.
After adjusting for key differences in baseline characteristics and prognostic factors, liso-cel demonstrated higher objective response and complete response rates compared with mosunetuzumab. Liso-cel was also associated with longer duration of response and improved progression-free survival. These results were consistent across sensitivity analyses and suggest more durable disease control with liso-cel in the 3L+ R/R FL population.
Safety outcomes were largely comparable between the 2 therapies. Liso-cel was associated with a higher incidence of any-grade cytokine release syndrome (CRS) and neurological events but demonstrated lower rates of grade ≥3 CRS and serious infections. The analysis also showed reduced corticosteroid use for CRS management with liso-cel, while tocilizumab use was higher.
These findings align with prior indirect comparisons between mosunetuzumab and other CAR T-cell therapies, including tisagenlecleucel and axicabtagene ciloleucel, which similarly reported improved efficacy outcomes with CAR T-cell treatment. The current study represents the first MAIC comparing liso-cel directly with mosunetuzumab and supports the potential for liso-cel to offer a favorable benefit-risk profile for patients with R/R FL after at least 2 prior lines of therapy.
While limitations inherent to indirect comparisons remain—such as differences in study design, safety reporting windows, and unmeasured confounders—the consistency of results across multiple endpoints strengthens the clinical relevance of the findings. Head-to-head clinical trials and further real-world evidence will be important to confirm these observations and inform treatment strategies in advanced FL.
Reference
Nastoupil LJ, Bonner A, Wang P, et al. Matching-adjusted indirect comparison of efficacy and safety of lisocabtagene maraleucel and mosunetuzumab for the treatment of third-line or later relapsed or refractory follicular lymphoma. Exp Hematol Oncol. 2025;14(1):30. doi:10.1186/s40164-025-00610-1
