Axicabtagene ciloleucel in vivo expansion and treatment outcome in aggressive B-cell lymphoma in a real-world setting.

Abstract

Data on the association between chimeric antigen receptor (CAR)-T-cell kinetics and patient outcome in the nontrial setting are missing, mainly due to the lack of broadly available CAR-T-cell diagnostic quantification tools. We performed prospective quantification of axicabtagene ciloleucel (axi-cel) in 21 patients treated for aggressive B-cell lymphoma at our clinic. Median peak CAR-T-cell count was 16.14 CAR-T cells/µL. Patients with 16.14/μL or higher peak CAR-T cells (strong expanders) had more day-30 objective responses (91% vs 40%, P = .02). In univariate analysis, peak CAR-T cell ≥ 16.14 (P < .001), normal platelet counts at start of lymphodepletion (P < .001), no prior stem cell transplant (P = .04), and peak CAR-T cells as continuous variable (P = .03) were associated with better progression-free survival (PFS). After adjusting for platelet counts and prior stem cell transplantation, peak CAR-T cells below median was still associated with shorter PFS (relative risk, 0.15, 95% confidence interval, 0.04-0.59, P = .007). Low platelet counts also maintained significant impact on PFS. Our data demonstrate association of axi-cel levels and outcome in a nontrial setting and for the first time use a cutoff to segregate weak and strong expanders with respective outcomes.

• Authors: Francis A Ayuk, Carolina Berger, Anita Badbaran, Tatjana Zabelina, Tanja Sonntag, Kristoffer Riecken, Maria Geffken, Dominic Wichmann, Christian Frenzel, Guenther Thayssen, Silke Zeschke, Nicolaus Kröger, Boris Fehse
• Journal: Blood advances (Blood Adv) Vol. 5 Issue 11 Pg. 2523-2527 (06 08 2021) ISSN: 2473-9537 [Electronic] United States
• PMID: 34100900 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2021 by The American Society of Hematology.

Chemical References

• Antigens, CD19
• Biological Products
• axicabtagene ciloleucel

Topics

• Antigens, CD19 (therapeutic use)
• Biological Products
• Humans
• Immunotherapy, Adoptive
• Lymphoma, Large B-Cell, Diffuse
• Prospective Studies
• Treatment Outcome