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  3. Outcomes of Salvage Therapy after Early-Line CD19 Chimeric Antigen Receptor T-Cell Failure in Large B-Cell Lymphoma

Outcomes of Salvage Therapy after Early-Line CD19 Chimeric Antigen Receptor T-Cell Failure in Large B-Cell Lymphoma

Fecha de publicación:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Escribano Serrat S.
  • Ip A.
  • Gomez-Llobell M.
  • Einarsdottir S.
  • Marcus R.
  • Valid O.B.
  • Accav N.G.
  • Nagler A.
  • Yehuda M.B.
  • Ahmad Y.A.
  • Ringeltein-Harlev S.
  • Greenbaum U.
  • Goy A.
  • Fei T.
  • Geva M.
  • Salles G.
  • Luttwak E.
  • Scordo M.
  • Palomba M.L.
  • Lue J.K.
  • Park J.H.
  • Schöder H.
  • Sauter C.
  • Ucpinar B.A.
  • Shah G.
  • Rejeski K.
  • Beyar-Katz O.
  • Avigdor A.
  • Perales M.-A.
  • Shouval R.

Grupos

Abstract

The approval of CD19 chimeric antigen receptor T-cell (CAR-T) therapy in the second-line (2L) setting for large B-cell lymphoma (LBCL) has reshaped treatment sequencing and the population at risk for post–CAR-T relapse; however, management after failure of early-line CAR-T therapy remains informed largely by later-line cohorts. We conducted an international, multicenter retrospective study of adults with LBCL treated with 2L or third-line (3L) CAR-T therapy to evaluate clinical characteristics, salvage strategies, and outcomes following relapse or progression. Among 545 patients, the 1-year cumulative incidence of relapse or progression after CAR-T was 40%. Of 235 patients who relapsed or progressed, 193 received salvage therapy, with an overall response rate (ORR) of 47%. One-year event-free survival (EFS) and overall survival (OS) after salvage were 18% and 44%, respectively. Outcomes were comparable after 2L and 3L CAR-T therapy, with no independent association between CAR-T line and EFS or OS in multivariable analyses. Relapse within 3 months of CAR-T infusion was strongly associated with inferior response and survival. Post–CAR-T salvage therapy consisted of heterogeneous regimens, most commonly polatuzumab–bendamustine–rituximab and CD20 × CD3 bispecific antibody monotherapy. Response rates and short-term survival varied across approaches, with bispecific antibody monotherapy having the highest ORR (65%) and favorable 1-year outcomes (OS 56%; EFS 43%). In this contemporary multicenter cohort, salvage therapy after CAR-T failure achieved objective but often short-lived responses, with outcomes driven by relapse timing after CAR-T infusion rather than the line of prior CAR-T therapy, supporting individualized treatment selection in this high-risk setting. © 2026 Published by Elsevier Inc. on behalf of American Society for Transplantation and Cellular Therapy.

Datos de la publicación

ISSN/ISSNe:
2666-6375, 2666-6367

Transplantation And Cellular Therapy  ELSEVIER SCIENCE INC

Tipo:
Article
Páginas:
-
PubMed:
41942005
Enlace a otro recurso:
www.scopus.com

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Keywords

  • CAR-T; CD19; LBCL; Progression; Relapse; Salvage therapy

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