Treatment outcomes in patients with large B-cell lymphoma after progression to chimeric antigen receptor T-cell therapy.

Fecha de publicación: 01/05/2024

Autores de IIS La Fe

• Gloria Iacoboni Garcia-Calvo

  Autor

• Jesus Delgado Ochando

  Autor

• Manuel Nuno Direito De Morais Guerreiro

  Autor

• Rafael Hernani Morales

  Autor

• Joan Antoni Teixidor Sureda

  Autor

Participantes ajenos a IIS La Fe

• Iraola-Truchuelo, Josu
• O'Reilly, Maeve
• Navarro, Victor
• Menne, Tobias
• Kwon, Mi
• Martin-Lopez, Ana Africa
• Chaganti, Sridhar
• Roddie, Claire
• Perez, Ariadna
• Norman, Jane
• Gibb, Adam
• Caballero, Ana Carolina
• Besley, Caroline
• Martinez-Cibrian, Nuria
• Mussetti, Alberto
• Sanderson, Robin
• Luzardo, Hugo
• Iyengar, Sunil
• Sanchez, Jose Maria
• Jones, Ceri
• Sancho, Juan-Manuel
• Barba, Pere
• Latif, Anne-Louise
• Lopez-Corral, Lucia
• Reguera, Juan Luis
• Garcia-Sancho, Alejandro Martin
• Bastos, Mariana
• Abrisqueta, Pau
• Kuhnl, Andrea

Grupos

• Hematología y Hemoterapia

  

  Investigador Principal

  Javier De La Rubia Comos

Abstract

Over 60% of relapsed/refractory (R/R) large B-cell lymphoma (LBCL) patients who receive chimeric antigen receptor (CAR) T cells will experience disease progression. There is no standard next line of therapy and information in this setting is scarce and heterogeneous. We analyzed 387 R/R LBCL patients who progressed after CAR T cells from July 2018 until March 2022 in Spain and the United Kingdom. Median overall survival (OS) was 5.3 months, with significant differences according to the interval between infusion and progression (<2 months [1.9 months], 2-6 months [5.2 months], and >6 months [not reached]). After progression, 237 (61%) patients received treatment. Focusing on the first subsequent therapy, overall (complete) response rates were 67% (38%) for polatuzumab-bendamustine-rituximab (POLA), 51% (36%) for bispecific antibodies (BsAb), 45% (35%) for radiotherapy (RT), 33% (26%) for immune checkpoint inhibitors (ICIs), 25% (0%) for lenalidomide (LENA), and 25% (14%) for chemotherapy (CT). In terms of survival, 12-month progression-free survival and OS was 36.2% and 51.0% for POLA, 32.0% and 50.1% for BsAb, 30.8% and 37.5% for RT, 29.9% and 27.8% for ICI, 7.3% and 20.8% for LENA, and 6.1% and 18.3% for CT. Thirty-two (14%) patients received an allogeneic hematopoietic cell transplant with median OS not reached after a median follow-up of 15.1 months. In conclusion, patients with R/R LBCL who progress within the first 2 months after CAR T-cell therapy have dismal outcomes. Novel targeted agents, such as polatuzumab and BsAbs, can achieve prolonged survival after CAR T-cell therapy failure.

Keywords

• NON-HODGKIN-LYMPHOMA; SINGLE-ARM; OPEN-LABEL; MULTICENTER; LENALIDOMIDE