Abstract |
Despite the success of CD19-targeted chimeric antigen receptor (CAR T)-cell therapy in patients with relapsed/refractory large B-cell lymphoma (LBCL), there is a need for effective salvage strategies post-CAR T-cell therapy failure. We conducted a multi-institutional retrospective study of patients who relapsed following CAR T-cell therapy ( axicabtagene ciloleucel [axi-cel] or tisagenlecleucel [tisa-cel]) and received salvage therapies ( radiation therapy [RT] alone, systemic therapy alone, or combined modality therapy [CMT]). A total of 120 patients with post-CAR T relapsed LBCL received salvage therapies (RT alone, 25 patients; CMT, 15 patients; systemic therapy alone, 80 patients). The median follow-up from CAR T-cell infusion was 10.2 months (interquartile range, 5.2-20.9 months). Failure occurred in previously involved sites prior to CAR T-cell therapy in 78% of patients (n=93). A total of 93 sites were irradiated in 54 patients who received any salvage RT post-CAR T failure. The median dose/fractionation were 30 Gy (range, 4-50.4 Gy) and 10 fractions (range, 1-28 fractions). The 1-year local control rate for the 81 assessable sites was 84%. On univariate analysis, the median overall survival (OS) from the start date of RT was significantly higher among patients who received comprehensive RT versus focal RT (19.1 months vs. 3.0 months; P=<0.001). Twenty-three of 29 patients who received comprehensive RT had limited-stage disease. Among these, there was no difference in median OS among the patients who received RT alone versus those who received RT followed by additional therapies (log-rank P=0.2). On multivariate survival analysis, achieving PR or CR post-CAR T (hazard ratio =0.5; 95% confidence interval: 0.3-0.9; P=0.01) was independently associated with superior OS. Our findings suggest that RT can provide local control for LBCL relapsed post-CAR T-cell therapy, particularly in patients with limited-stage relapsed disease treated with comprehensive RT.
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Authors | Hazim S Ababneh, Andrea K Ng, Matthew J Frigault, Jeremy S Abramson, Patrick Connor Johnson, Caron A Jacobson, Chirayu G Patel |
Journal | Haematologica
(Haematologica)
Vol. 108
Issue 11
Pg. 2972-2981
(11 01 2023)
ISSN: 1592-8721 [Electronic] Italy |
PMID | 37317884
(Publication Type: Journal Article)
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Chemical References |
- Receptors, Chimeric Antigen
- Antigens, CD19
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Topics |
- Humans
- Immunotherapy, Adoptive
(adverse effects)
- Receptors, Chimeric Antigen
- Retrospective Studies
- Lymphoma, Large B-Cell, Diffuse
(radiotherapy)
- Survival Analysis
- Antigens, CD19
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