Despite the clinical success of T cell-based immunotherapies such as CAR-T cells and bispecific T cell engagers (BiTEs), therapeutic resistance and immune suppression remain significant barriers in B-cell malignancies. To address these, we developed a novel dual-functional extracellular vesicle (EV) platform, termed BiTE EV@STA, that displays anti-CD3/CD19 BiTE molecules on the EV surface while encapsulating a STING agonist (STA). This strategy enables simultaneous redirection of cytotoxic T cells to tumor cells and stimulation of innate immunity within the tumor microenvironment (TME). BiTE EVs demonstrated favorable pharmacokinetics, enhanced tumor targeting, and robust T cell dependent cytotoxicity and cytokine release. In Nalm6-Luc xenograft models, BiTE EVs significantly inhibited tumor progression and prolonged survival. Further loading of STING agonists into EVs (BiTE EV@STA) activated dendritic cells, and enhanced CD8⁺ T cell infiltration in the TME. Notably, BiTE EV@STA achieved a 4-fold increase in tumor growth inhibition and a marked survival benefit compared to either component alone. This study presents BiTE EV@STA as a promising EV-based immunotherapy that integrates adaptive and innate immune activation to overcome TME-mediated resistance. These findings may have broad implications for enhancing T cell-based therapies in hematologic malignancies and beyond.

Clear cell renal cell carcinoma (ccRCC) remains a challenging malignancy to treat, with immune checkpoint inhibitors (ICIs) revolutionizing patient management. This pilot study, evaluated the efficacy and safety of combination therapy comprising camrelizumab, an anti-PD-1 antibody, and autologous cytokine-induced killer (CIK) cell therapy in patients with refractory ccRCC. Twenty-one patients with refractory ccRCC were randomly assigned to receive either camrelizumab monotherapy (control group, n = 12) or camrelizumab combined with CIK cell re-transfusion (trial group, n = 9). Due to early termination (21 of 60 planned patients), all endpoints were exploratory. The objective response rate (ORR) was numerically higher in the combination group (55.6% vs. 41.7%; odds ratio 1.75, 95% confidence interval [CI]: 0.32-9.51), but not statistically significant. Median progression-free survival (PFS) was 28.5 vs. 8.67 months (hazard ratio [HR] 0.40, 95% CI: 0.12-1.34), and median overall survival (OS) was not reached vs. 57.47 months (HR 0.48, 95% CI: 0.09-2.53). One patient in the trial group achieved a complete metabolic response (CMR). The combination was well-tolerated without new safety signals. Exploratory analysis suggested that higher baseline PD-1 expression on CD8+ T cells might be associated with a better response, and the frequency of PD-1 positive cells tended to decrease after camrelizumab administration. The addition of CIK cell therapy to anti-PD-1 antibody showed signals of potential benefit in refractory ccRCC with a tolerable safety profile. This pilot study suggests the combination approach appears feasible and warrants investigation in larger trials in pretreated ccRCC patients.Registry: ClinicalTrials.gov, TRN: NCT03987698, Registration date: 17 June 2019.

In the last decades, critical advancements in research technology and knowledge on disease mechanisms steered therapeutic approaches for chronic inflammatory diseases towards unprecedented target specificity. For allergic and chronic lung diseases, biologic drugs pioneered this goal, acquiring on the way-through the clinical use of monoclonal antibodies-a deeper understanding of how inflammatory and immune pathways are configured in disease-specific patterns. In this biomarker-driven approach, synthetic small molecule drugs (SMDs) were perceived as lagging behind in innovation for their relative lack of specificity. This was, however, mostly due to a shift in focus towards biologics rather than true obsolescence of SMDs. In the same timeframe, in fact, advances in structural biology and medicinal chemistry, bioinformatics and artificial intelligence held steadily SMDs' innovation and relevance. The use of kinase inhibitors, well established in the treatment of cancer and rheumatological diseases, is now approved for some allergic skin diseases and is approaching asthma and COPD with several clinical trials; moreover, new therapeutics targeting mast cell receptors and molecules involved in innate immunity are entering preclinical and clinical testing. Alongside, the portfolio of biologics is harboring the expansion of RNA therapeutics, which gained global recognition during the COVID-19 pandemic due to RNA vaccines. Different types of RNA therapeutics, including those based on different non-coding RNAs, are advancing to agency approval and market, thanks to improvements in molecule stability and delivery systems. In summary, the evidence presented in this position paper illustrates that precision medicine is becoming a goal shared between synthetic SMDs and biologics, both protein/antibody-based and RNA therapeutics. We review the current state, unmet needs and opportunities within this evolving landscape, highlighting how small molecular species, both synthetic as SMDs and biologic in nature as RNA, can contribute to the precision medicine approach along with protein and antibody-based biologics and cell therapies.

Antigen heterogeneity remains a major obstacle to the effective application of chimeric antigen receptor (CAR)-T cell therapy in solid tumors. We investigated the potential of epitope spreading as a strategy to overcome this limitation and examined whether CAR-T cells concomitantly producing IL-7 and CCL19 (7 × 19 CAR-T cells) could act as potent inducers of epitope spreading, as well as the underlying mechanisms. We used a murine model inoculated with a mixture of cancer cell lines-genetically modified to express the CAR target antigen-and their respective parental lines lacking target expression. Following administration of 7 × 19 CAR-T cells, flow cytometry and peptide stimulation assays were performed to evaluate the induction of tumor antigen-specific T cells and dendritic cells within tumor-draining lymph nodes and tumor tissues. We also evaluated the antitumor efficacy of 7 × 19 CAR-T cells derived from an allogeneic donor and their capacity to induce epitope spreading in vivo and ex vivo. In multiple tumor mixture models, 7 × 19 CAR-T cells demonstrated marked antitumor activity and promoted epitope spreading in murine solid tumor models, enabling endogenous T cells to recognize and target tumor-associated antigens. This response was dependent on cross-presentation by defined dendritic cell subsets in both the tumor microenvironment and tumor-draining lymph nodes within 2weeks of 7 × 19 CAR-T cell administration. Notably, 7 × 19 CAR-T cells derived from allogeneic donors also induced epitope spreading in tumor-bearing hosts, thereby increasing survival. The 7 × 19 CAR system is a promising strategy for overcoming antigen heterogeneity in solid tumors by promoting epitope spreading.

CD19-specific CAR T cells engineered to secrete a constitutively active form of the pro-inflammatory cytokine, interleukin (IL)-18 have demonstrated impressive efficacy in a recent clinical trial involving subjects who had failed prior CAR T cell therapy. Corroborating these clinical data, preclinical studies of IL-18-armored CAR and T cell receptor-engineered T cells have demonstrated enhanced anti-tumor activity in several xenograft and syngeneic mouse cancer models. Interleukin-18 improves tumor clearance via direct effects on CAR T cells and indirect actions on cells on a variety of host immune cells, including natural killer, macrophage and dendritic cells. Compared to unarmored CAR T cells, IL-18-secreting CAR T cells are less exhausted, expand more efficiently and produce greater quantities of interferon (IFN)-γ. However, upregulated circulating IL-18 and its downstream mediator, IFN-γ, are also associated with systemic toxicities which have proven to be severe on occasions. In light of this, several groups have developed strategies that set out to restrict IL-18 release or biological activity to the tumor microenvironment. Among these, CAR T cells armored with NFAT-inducible IL-18 are now undergoing clinical testing. The evaluation of inducible or tumor-selective IL-18 deployment will show whether it is possible to minimize IL-18 related systemic toxicities while preserving localized amplification of anti-tumor activity.

Background Anti-CD19 chimeric antigen receptor (CAR)-T cell therapy has demonstrated clinical potential in treating relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL); however, enhancing its therapeutic efficacy remains a significant challenge. To this end, bridging therapy with Brutonyg tyrosine kinase inhibitors (BTKi), such as ibrutinib or zanubrutinib, is being investigated as a strategy to improve treatment outcomes. Patients and methods In this retrospective analysis, we assessed the impact of different durations of BTKi bridging therapy prior to anti-CD19 CAR-T cell infusion in 33 patients with R/R DLBCL. Patients meeting predefined eligibility criteria, including the presence of at least one high-risk prognostic factor. These 33 patients were stratified into two groups based on the duration of BTKi exposure: ≥x months versus <2 months. Results The R/R DLBCL patients receiving BTKi for ≥o months demonstrated a higher overall response rate than the patients receiving BTKi for <2 month. There was no statistically significant differences in progression free survival (PFS) or overall survival (OS) between the two groups. Exploratory analyses suggested potential biomarkers for BTKi bridging efficacy, including modulation of nicotinamide phosphoribosyltransferase (NAMPT) and programmed cell death protein 1 (PD-1). Conclusions Prolonged BTKi bridging might improve the overall response to CAR-T cell therapy in patients with R/R DLBCL, despite the initial disparities. However, the risk of hematological toxicity associated with extended BTKi use requires attention. Further investigations are essential to validate and translate these observations into clinical practice, thus highlighting the need for further research in this area. Clinical Trial Registration https://www.chictr.org.cn/showproj.aspx?proj=33185 , ChiCTR1800019622

Commentary: Efficacy of stem cell therapy for diabetic kidney disease: a systematic review and meta-analysis

CAR-T cell therapies such as lisocabtagene maraleucel (liso-cel) have transformed the treatment of patients with second line primary refractory or early relapsed ≤ 12 months (R/R) large B-cell lymphoma (LBCL). The objective of this study was to assess the cost-effectiveness of liso-cel compared to standard of care (SOC) to treat R/R LBCL in France. A 3-health-state model was developed to compare liso-cel to SOC over 20 years in France. Efficacy and safety were extrapolated from the TRANSFORM trial (NCT03575351), or DESCAR-T (registry of patients treated with a CAR-T in France). Costs were calculated using French-specific sources. Outcomes were quality-adjusted life years (QALY), life-years (LY), total costs, incremental cost-utility and cost-effectiveness ratios (ICUR, ICER). Probabilistic sensitivity analysis (PSA) was conducted to assess the robustness of the results. Liso-cel generated 5.7 QALY (6.4 LY) for a €265 907. SOC generated 4.4 QALY (5.1 LY) for €233 903. ICUR and ICER were estimated at €24 580/QALY and €23 464/LY gained versus SOC. PSA showed that liso-cel was more effective and more costly in 92% of the simulations. Liso-cel is cost-effective versus SOC to treat R/R LBCL patients in France. Generation of long-term real-world data is needed in order to validate these findings.

Despite important advancements in diagnostic modalities, routine use of therapeutic drug monitoring (TDM) and newer antifungal therapies, there is a paucity of contemporary data regarding clinical characteristics and outcomes of invasive aspergillosis (IA) in the United States. Single-center, retrospective cohort study of hospitalized patients between 2015 and 2020, who had active hematological malignancy (HM) or had undergone transplantation and cellular therapy (TCT) and had probableorproven IA. Sixty-two patients with probableorproven IA, including 21 HM and 41 TCT, were identified. Forty-four percent of the cases corresponded to breakthrough IA. Bronchoalveolar lavage galactomannan was ≥ 1 in 71% and ≥ 0.5 in 88%, while serum galactomannan was ≥ 0.5 in only 34%. Among assessable patients (n = 59), 90-day partial or complete response to antifungal therapy occurred in 39%. All-cause mortality for the entire cohort was 22% at 30days and 46% at 90days. IA attributable mortality was 18% at 30days and 38% at 90days. Achieving therapeutic antifungal serum levels was associated with a reduction in all-cause mortality, while prior clinically significant CMV infection (aOR 9.65, 95% CI 1.34-69.6; P = 0.025) and relapsed/refractory hematological disease (aOR 8.5, 95% CI 2.23, 32.4; P = 0.002) were associated with higher IA attributable mortality. Despite advancements in diagnosis and treatment, IA remains associated with poor outcomes in hematological patients in the contemporary era. Newer antifungals and improved strategies for monitoring and prevention of IA in these vulnerable patient populations are urgently needed.

Neoantigen-based adoptive T cell therapies (ACTs) represent a promising avenue in cancer immunotherapy due to their exquisite tumor specificity. The first cell-based immunotherapy for a solid tumor, comprising tumor-infiltrating lymphocytes, recently received FDA approval. Building on this, we designed a distinct ACT approach, where T cell responses against personalized neoantigens are systematically generated from autologous peripheral blood. Here we report the establishment of NEO-STIM, an ex vivo induction process to prime and expand pre-existing memory and de novo CD8+ and CD4+ T cell responses, thereby highlighting critical parameters for generating potent neoantigen-specific T cell responses. The drug products comprise mutant-reactive, polyfunctional, and cytotoxic CD8+ and CD4+ T cells, able to recognize autologous tumor material. Following infusion, T cell responses are detected in tumor and blood of a patient, and display activated/exhausted and cytotoxic phenotypes. A first-in-human clinical trial (NCT04625205) recently further validated proof-of-concept, supporting continued development of this ACT approach.

Background Plasma cell leukemia (PCL) is a rare and aggressive hematological malignancy. The long-term prognosis of relapsed/refractory plasma cell leukemia (R/R PCL) remains poor, and few treatment options are available for patients with triple-refractory disease. Chimeric antigen receptor (CAR)-T cell therapy targeting the B-cell maturation antigen (BCMA) has shown promise, though its long-term efficacy and optimal subsequent strategies remain to be fully elucidated. Methods This retrospective study analyzed the efficacy and safety of BCMA CAR-T therapy in 12 patients with triple-class R/R PCL. Patients were stratified into consolidation (Group 1, allo-HSCT within 3 months post-CAR-T) and non-consolidation (Group 2, no allo-HSCT within 3 months post-CAR-T) groups, with survival outcomes compared between cohorts. Results The overall response rate following BCMA-CAR-T cell therapy was 75% (9/12); four patients achieved partial response, four achieved very good partial response, and one patient had complete response. Grade 3–4 cytopenia were universally observed, while 83.3% (10/12)of the patients presented with mild (grade 1-2) cytokine release syndrome. The median progression free survival (PFS) was 8.9 months (95% CI: 4.6, not reached). The 1-year PFS rate was 33.3% (95% CI: 7.8–62.3), and the 2-year PFS rate was 22.2% (95% CI: 3.4–51.3). The median overall survival (OS) was 15.5 months (95% CI: 5.7, not reached). The 1-year OS rate was 55.6% (95% CI: 20.4–80.5), and the 2-year OS rate was 22.2% (95% CI: 3.4–51.3). furthermore, two of the four patients who underwent consolidation therapy showed long-term survival with stringent complete response. Conclusions BCMA-CAR-T therapy confers short-term remission and survival benefits in relapsed/refractory plasma cell leukemia (R/R PCL). However, the definitive value of allogeneic hematopoietic stem cell transplantation (allo-HSCT) awaits validation in large-sample prospective studies.

Stochasticity in cancer immunotherapy stems from rare but functionally critical Spark T cells.

Colorectal cancer (CRC) remains a significant global health concern and is among the leading causes of cancer-related mortality. The disease often progresses to more advanced and treatment-resistant stages. By 2040, the incidence of CRC is projected to increase substantially worldwide, particularly in low- and middle-income countries. Despite the availability of various treatment modalities, CRC incidence remains elevated. Extracellular vesicles (EVs), including exosomes, microvesicles, and apoptotic bodies, represent a novel approach for CRC therapy and diagnosis. EVs possess distinct biological characteristics and exhibit both immunosuppressive and immunostimulatory properties within the tumour microenvironment. Tumour-derived EVs facilitate CRC progression and metastasis by transferring oncogenic proteins and microRNAs that promote epithelial-mesenchymal transition and alter recipient cell behaviour. Conversely, immune-derived EVs produced by dendritic cells, natural killer cells, T lymphocytes, B lymphocytes, and macrophages enhance anti-tumour immune responses and contribute to the elimination of cancer cells. Due to their stable encapsulation of nucleic acids, proteins, and lipids, EVs serve as highly sensitive and specific biomarkers for CRC diagnosis, prognosis, and therapeutic monitoring. Additionally, EVs have demonstrated both abscopal and bystander effects, highlighting their capacity to induce systemic antitumor responses. Recent advances in EV engineering, together with emerging technologies such as artificial intelligence, CRISPR/Cas9 genome editing, and chimeric antigen receptor (CAR)-T cell therapy, present new opportunities to optimise EV-based interventions and broaden their translational applications. Nevertheless, substantial challenges persist, including EV heterogeneity, technical barriers in isolation and characterisation, and limited understanding of their functional diversity. Addressing these limitations, particularly in the development of EV-based vaccines, enhancement of immunostimulatory properties, and further integration of artificial intelligence, will be essential for realising the full clinical potential of EVs in colorectal cancer management.

Chimeric antigen receptor (CAR) T cell therapy was recently proposed as a treatment for adults with B-cell-mediated autoimmune diseases (ADs) refractory to conventional immunomodulatory therapy. We present a case series of eight children with severe/refractory AD (four systemic lupus erythematosus, three dermatomyositis, one systemic sclerosis) treated at Ospedale Pediatrico Bambino Gesù, Rome, and University Hospital Erlangen with a single infusion of 1 × 106 kg-1 point-of-care manufactured autologous CD19 CAR T cells (zorpocabtagene autoleucel), in a hospital exemption (HE) program. In Europe, the HE pathway offers the opportunity to treat patients with life-threatening or seriously debilitating disorders who lack valid therapeutic options, using an advanced therapy medicinal product (ATMP) authorized on a nonroutine, single-patient basis. In contrast to the 'compassionate use' pathway, the ATMP does not necessarily need to have undergone clinical trials or marketing authorization applications. Manufacturing was successful in all patients, yielding several drug product bags. Once infused after lymphodepletion, zorpocabtagene autoleucel cells expanded in vivo, promoting prompt B cell clearance. Grade 1 cytokine release syndrome was reported in six patients, and grade 1 immune effector cell-associated neurotoxicity syndrome was reported in one patient. Late-hematotoxicity was limited to grade 1 in two patients. All these adverse events were manageable and no severe infections occurred. With a median follow-up of 16.5 months (range = 9-24 months), all patients experienced a clinically substantial improvement/resolution of AD, as evidenced by reduction in disease activity scores and signs of reversal of organ damage. This improvement enabled sustained discontinuation of immunomodulators, even after B cell reconstitution. The activation of formal clinical trials enrolling children and adolescents is urgently needed to confirm these preliminary results and to assess the long-term safety of this approach.

miR-340 improves the efficiency of p53 gene therapy in metastatic prostate cancer cells through downregulation of MDM2.

Venetoclax (VEN) is a B-cell lymphoma 2 (BCL-2) inhibitor approved for treatment in acute myeloid leukemia (AML). Human heavy chain ferritin (HFn) is a bio-inspired nanoparticle (NP) utilized to deliver multiple chemotherapies to tumor cells through CD71-mediated endocytosis. In this study, the efficacy of VEN/HFn NP was investigated for targeted delivery in AML. Recombinant HFn was expressed, purified, and characterized using SDS-PAGE, western blotting, and dynamic light scattering (DLS). VEN was encapsulated in HFn, and the resulting VEN/HFn NPs, along with the corresponding controls, were utilized to treat the AML cell lines THP-1 and K562. Cell proliferation, apoptosis, and CD71 and HLA-I expression levels were assessed using MTT and flow cytometry assays. The mRNA expression of IFN-β and BCL-2 was measured using Real-time PCR. Drug-nanoparticle interactions were analyzed using molecular docking. HFn NPs were successfully constructed with a 95% VEN encapsulation efficiency, supported by molecular docking simulations that indicated a strong binding affinity (-9.2kcal/mol) and a thermodynamically stable complex. Functionally, both VEN/HFn and free VEN treatments significantly induced apoptosis and upregulated HLA-I and IFN-β expression in both cell lines. Also, BCL-2 expression was significantly reduced. Importantly, no significant differences in these effects were observed between the VEN/HFn and free VEN, confirming that encapsulation preserves the drug's activity. Our results indicate a promising and efficient strategy for the encapsulation and targeted delivery of venetoclax using HFn nanoparticles for AML patients. This delivery system can support co-delivery of various drugs and combination therapy of tumor cells.

Ashwagandha (W. somnifera), known for its broad health benefits, has shown potential in cancer prevention and treatment. The aim of this study was to investigate the potential effect of ashwagandha aqueous extract (ASH-AE) on cell proliferation and therapy resistance markers in hepatocellular carcinoma (HCC). An in vitro study was conducted using the HepG2 cell line. The HepG2 cells were divided into 4 groups according to the treatment regimen received. ASH-AE was extracted from the whole plant and characterized by GC-MS and HPLC. HepG2 cell viability was determined for all groups. The protein expression of cluster of differentiation 90 (CD90) was determined by flow cytometry technique. Also, the gene expression of Sonic Hedgehog (SHH), Patched 1(PTCH1) and ATP-binding cassette subfamily C1 (ABCC1) was assayed by qRT-PCR. The protein expression and localization of glioma-associated oncogene 1 (Gli1) in HepG2 cells were determined by immunocytochemistry (ICC) assay. The results indicated that ASH-AE either alone or in combination with sorafenib (SOR) significantly reduced HepG2 cell viability in a concentration dependent manner (P ˂0.001) with IC50 was 6.65mg/ml for ASH-AE, 11.3 µM for SOR, and 5.6mg/ml + 18.6 µM for ASH-AE in combination with SOR. Moreover, SOR significantly increased the percentage of CD90+ cells and Gli1 protein expression and nuclear translocation as well as ABCC1 gene expression compared to untreated cells. On the other hand, ASH-AE either alone or in combination with SOR significantly decreased the percentage of CD90+ cells and Gli1 expression and nuclear translocation as well as SHH, PTCH1 and ABCC1 gene expression compared to untreated cells and that treated with SOR. We concluded for the first time that the combination of SOR and ASH-AE generates antagonistic antitumor effect in HepG2 cells. Moreover, ASH-AE can inhibit proliferation of HepG2 cells and mitigate sorafenib-induced resistance-associated markers in HepG2 cells by targeting CD90+ cells via Hedgehog pathway modulation.

The term "regenerative" now describes an extraordinarily broad range of therapies: advanced cell and gene therapies sit alongside off-the-shelf scaffolds, injectable biologics, and topical formulations. Yet there are no agreed criteria for what regenerative means. Assessment tools that do exist focus on single tissues and were never designed to compare different product types. As a result, regenerative labeling is largely self-assigned and often binary: a product is either regenerative or it is not.This manuscript proposes the Regenerative Potential Score (RPS), a conceptual framework to quantify how regenerative a product is within a specific tissue context. The RPS looks at three aspects of regeneration: how cells respond, how much new matrix forms, and whether the product integrates functionally in vivo. Each aspect is measured using two core assays. Results are converted to standardized effect sizes and combined into a single score. The framework anchors these numbers to negative controls and current best-practice treatments, so scores reflect real clinical differences rather than arbitrary thresholds. The goal is to provide a shared language that makes comparisons more transparent and pushes the field toward consensus-based testing standards.

BK virus infection is a marker of poor immune recovery, especially after kidney or allogeneic cell transplantation. Because of the challenges associated with BK virus infection and the lack of effective treatments, there is a growing interest in novel approaches, such as adoptive cellular therapy, that aim to restore antiviral immunity and promote viral clearance. Our clinical trial assessed the feasibility, safety, and efficacy of administering third-party, BK virus-specific cytotoxic T lymphocytes (CTLs) used to treat allogeneic HCT patients and kidney transplant patients with biopsy-proven BK-virus nephropathy. Comprehensive clinical assessments and correlative studies were performed. The study included six patients after kidney-transplantation and five HCT recipients. Viremia declined in most evaluable patients by Day 45 after BKCTL infusion. No new instances of graft-versus-host disease, kidney-transplant rejection, graft failure, or infusion-related toxicities were attributed to the treatment. Antiviral activity (as assessed by interferon-γ secretion) did not differ between infused BKV-CTLs given to kidney-transplant versus allogeneic SCT recipients. In this study, we longitudinally tracked the in vivo persistence of adoptively transferred BKV-CTLs and demonstrated their sustained functional activity. This therapy could be promising in KT and SCT patients with recent-onset BK-virus viremia.

Chimeric Antigen Receptor (CAR) T-cell therapy is an established treatment for relapsed or refractory large B-cell lymphoma (rr LBCL). While clinical efficacy is well documented, data on health-related quality of life (HRQoL) remain limited. This study assessed HRQoL in rr LBCL patients with long-term remission after CAR T-cell therapy versus high-dose chemotherapy with autologous stem cell transplantation (HD-ASCT).Twenty-eight consecutive rr LBCL patients in sustained remission were analyzed, with 15 receiving CAR T-cell therapy (tisagenlecleucel) and 13 undergoing HD-ASCT between 2019 and 2023. HRQoL was assessed using EQ-5D-5L and PROMIS-29 questionnaires at 12 months and at a median of 36.8 months (range 15.7-57.2 months) post cellular therapy. Groups were compared for differences in HRQoL indices and domain scores.Median age was 63.5 (range 23-73) years. Twelve months post-treatment, CAR T-cell recipients reported significantly higher HRQoL scores than HD-ASCT patients (EQ-5D-5L index value: 0.89 ± 0.11 vs. 0.72 ± 0.21; p = 0.015). Consistently, PROMIS-29 revealed clinically meaningful advantages in the CAR T-cell cohort across all seven categories. At later follow-up, EQ-5D-5L index values converged (index-value 0.82 ± 0.22 vs. 0.7 ± 0.25; p = 0.2), whereas PROMIS-29 still indicated sustained benefit in five domains among CAR T-cell recipients.CAR T-cell therapy was associated with superior HRQoL in the first year compared to HD-ASCT. Although some differences diminished over time, CAR T-cell patients continued to experience better outcomes in several domains. These findings highlight clinical relevance of patient-reported outcome in rr LBCL, particularly in longitudinal surveys, and underscore the value of integrating patient-centered metrics into therapeutic decisions-making.