Chimeric antigen receptor T-cell (CAR T-cell) therapy is the standard of care for relapsed/refractory (R/R) large B-cell lymphoma (LBCL). The impact of pre-existing chronic obstructive pulmonary disease (COPD) on outcomes of LBCL after CAR-T cell therapy are not well characterized. This study aimed at evaluating the significance of pre-existing COPD on overall survival (OS) in LBCL treated with CAR-T cell therapy.

We conducted propensity score-matched cohort study using registry data from TriNetX Global Collaborative Network. Patients aged ≥18 years who received CAR T-cell therapy were identified using ICD-10-PCS and CPT codes and stratified by the presence (or absence) of documented diagnosis of COPD (ICD-10-CM: J44.x). Propensity score matching was performed adjusting for age, gender, ethnicity, and race. Primary outcome was OS. Secondary endpoints included hematologic and non-hematologic toxicities.

A total of 173 patients with COPD and 173 without COPD were included. Cohorts were balanced across baseline characteristics. Axicabtagene ciloleucel was the most commonly administered product in both cohorts. The COPD cohort demonstrated significantly worse median OS (760 vs. 1412 days). The 5-year OS was higher in patients without COPD (HR=0.72 (95%CI=0.52-0.99), p=0.048).

COPD is associated with inferior OS following CAR T-cell therapy in R/R LBCL. These results advocate for the integration of COPD status into pre-CAR T-cell risk stratification protocols and for proactive pulmonary optimization, multidisciplinary evaluation, and heightened vigilance in this cohort. Patients with R/R LBCL and concurrent COPD should not be categorically excluded from CAR T-cell therapy.