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Goyco Vera D, Waghela H, Nuh M, Pan J, Lulla P. Approved CAR-T therapies have reproducible efficacy and safety in clinical practice. Hum Vaccin Immunother 2024; 20:2378543. [PMID: 39104200 PMCID: PMC11305028 DOI: 10.1080/21645515.2024.2378543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/24/2024] [Accepted: 07/07/2024] [Indexed: 08/07/2024] Open
Abstract
CAR-T cell therapy has established itself as a highly effective treatment for hematological malignancies. There are currently six commercial CAR-T products that have been FDA approved for diseases such as B-ALL, LBCL, MCL, FL, MM, and CLL/SLL. "Real-world" studies allow us to evaluate outcomes from the general population to determine their efficacy and safety compared to those who were included in the original trials. Based on several well conducted "Real-world" studies that represent diverse populations, we report that outcomes from the original trials that led to the approval of these therapies are comparable to those in practice.
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Affiliation(s)
- Daniel Goyco Vera
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Hiral Waghela
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Mohamed Nuh
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jonathan Pan
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Premal Lulla
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Cell and Gene Therapy, Baylor College of Medicine, Houston Methodist Hospital, Texas Children’s Hospital, Houston, TX, USA
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2
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Stella F, Chiappella A, Casadei B, Bramanti S, Ljevar S, Chiusolo P, Di Rocco A, Tisi MC, Carrabba MG, Cutini I, Martino M, Dodero A, Bonifazi F, Santoro A, Sorà F, Botto B, Barbui AM, Russo D, Musso M, Grillo G, Krampera M, Olivieri J, Ladetto M, Cavallo F, Massaia M, Arcaini L, Pennisi M, Zinzani PL, Miceli R, Corradini P. A Multicenter Real-life Prospective Study of Axicabtagene Ciloleucel versus Tisagenlecleucel Toxicity and Outcomes in Large B-cell Lymphomas. Blood Cancer Discov 2024; 5:318-330. [PMID: 38953781 PMCID: PMC11369587 DOI: 10.1158/2643-3230.bcd-24-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/29/2024] [Accepted: 05/30/2024] [Indexed: 07/04/2024] Open
Abstract
This real-world prospective observational study across 21 Italian centers (CART-SIE) compares axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel) outcomes in 485 patients with relapsed/refractory large B-cell lymphoma with baseline characteristics matched by stabilized inverse propensity score weighting. Axi-cel versus tisa-cel had higher all-grade cytokine release syndrome (78.6% vs. 89.3%, P = 0.0017) and neurotoxicity (9.9% vs. 32.2%, P < 0.0001) but also superior progression-free survival (PFS) at 1 year (46.5% vs. 34.1%, P = 0.0009). Even among patients who failed bridging therapy, axi-cel PFS was superior to tisa-cel (37.5% vs. 22.7%, P = 0.0059). Differences in overall survival and high-grade immune toxicities were not significant. The CAR-HEMATOTOX score not only predicted hematologic toxicity but also 1-year survival outcomes (51.5% in CAR-HEMATOTOX high vs. 77.2% in CAR-HEMATOTOX low, P < 0.0001). Twenty patients developed second primary malignancies, including two cases of T-cell neoplasms. These findings enable more informed selection of anti-CD19 CAR T-cell therapy, balancing bridging, safety, and efficacy considerations for individual patients. Significance: The findings of this study on 485 patients with relapsed/refractory large B-cell lymphoma treated with commercial axi-cel and tisa-cel indicate axi-cel's superior PFS after propensity score weighting. The predictive utility of CAR-HEMATOTOX in assessing not only toxicity but also outcomes across both CAR T-cell products may guide future risk-stratified management strategies.
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MESH Headings
- Humans
- Male
- Female
- Middle Aged
- Prospective Studies
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/mortality
- Aged
- Biological Products/adverse effects
- Biological Products/therapeutic use
- Biological Products/administration & dosage
- Adult
- Antigens, CD19/immunology
- Antigens, CD19/therapeutic use
- Immunotherapy, Adoptive/adverse effects
- Immunotherapy, Adoptive/methods
- Treatment Outcome
- Receptors, Antigen, T-Cell/therapeutic use
- Receptors, Antigen, T-Cell/immunology
- Aged, 80 and over
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Affiliation(s)
| | - Annalisa Chiappella
- Division of Hematology and Stem Cell Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
| | - Beatrice Casadei
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy.
| | - Stefania Bramanti
- IRCCS Humanitas Research Hospital, Transplantation Unit Department of Oncology and Haematology, Milan, Italy.
| | - Silva Ljevar
- Unit of Biostatistics for Clinical Research, Department of Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
| | - Patrizia Chiusolo
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Alice Di Rocco
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
| | - Maria C. Tisi
- Hematology Unit, San Bortolo Hospital, Vicenza, Italy.
| | | | - Ilaria Cutini
- SOD Terapie Cellulari e Medicina Trasfusionale, AAD Trapianto di midollo osseo, Ospedale Careggi, Firenze, Italy.
| | - Massimo Martino
- Hematology and Stem Cell Transplantation and Cellular Therapies Unit (CTMO), Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano “Bianchi-Melacrino-Morelli”, Reggio Calabria, Italy.
| | - Anna Dodero
- Division of Hematology and Stem Cell Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
| | - Francesca Bonifazi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy.
| | - Armando Santoro
- IRCCS Humanitas Research Hospital, Transplantation Unit Department of Oncology and Haematology, Milan, Italy.
| | - Federica Sorà
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy.
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Barbara Botto
- SC Ematologia AOU Città della Salute e della Scienza, Torino, Italy.
| | - Anna M. Barbui
- Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy.
| | - Domenico Russo
- Unit of Blood Disease and Bone Marrow Transplantation, and Unit of Hematology, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy.
| | - Maurizio Musso
- UOC di Oncoematologia e TMO, Dipartimento Oncologico “La Maddalena”, Palermo, Italy.
| | - Giovanni Grillo
- Dipartimento di Ematologia e trapianto di midollo, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
| | - Mauro Krampera
- Hematology and Bone Marrow Transplant Unit, Section of Biomedicine of Innovation, Department of Engineering for Innovative Medicine (DIMI), University of Verona, Verona, Italy.
| | - Jacopo Olivieri
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari “Carlo Melzi”, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.
| | - Marco Ladetto
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale ed SCDU Ematologia AOU SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
| | - Federica Cavallo
- Division of Hematology, University Hospital A.O.U. “Città della Salute e della Scienza”, Turin, Italy.
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Turin, Turin, Italy.
| | - Massimo Massaia
- Division of Hematology–AO S. Croce e Carle, Cuneo and Laboratory of Blood Tumor Immunology, Molecular Biotechnology Center “Guido Tarone”, University of Torino, Torino, Italy.
| | - Luca Arcaini
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Martina Pennisi
- Division of Hematology and Stem Cell Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
| | - Pier L. Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy.
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.
| | - Rosalba Miceli
- Unit of Biostatistics for Clinical Research, Department of Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
| | - Paolo Corradini
- Chair of Hematology, University of Milan, Milano, Italy.
- Division of Hematology and Stem Cell Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
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Sýkorová A, Folber F, Polgárová K, Móciková H, Ďuraš J, Steinerová K, Obr A, Heindorfer A, Ladická M, Lukáčová Ľ, Čellárová E, Plameňová I, Belada D, Janíková A, Trněný M, Jančárková T, Procházka V, Vranovský A, Králiková M, Vydra J, Smolej L, Drgoňa Ľ, Sedmina M, Čermáková E, Pytlík R. Several factors that predict the outcome of large B-cell lymphoma patients who relapse/progress after chimeric antigen receptor (CAR) T-cell therapy can be identified before cell administration. Cancer Med 2024; 13:e70138. [PMID: 39248284 PMCID: PMC11382134 DOI: 10.1002/cam4.70138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 07/13/2024] [Accepted: 08/09/2024] [Indexed: 09/10/2024] Open
Abstract
AIM The aim of this study was to analyse the outcomes of patients with large B-cell lymphoma (LBCL) treated with chimeric antigen receptor T-cell therapy (CAR-Tx), with a focus on outcomes after CAR T-cell failure, and to define the risk factors for rapid progression and further treatment. METHODS We analysed 107 patients with LBCL from the Czech Republic and Slovakia who were treated in ≥3rd-line with tisagenlecleucel or axicabtagene ciloleucel between 2019 and 2022. RESULTS The overall response rate (ORR) was 60%, with a 50% complete response (CR) rate. The median progression-free survival (PFS) and overall survival (OS) were 4.3 and 26.4 months, respectively. Sixty-three patients (59%) were refractory or relapsed after CAR-Tx. Of these patients, 39 received radiotherapy or systemic therapy, with an ORR of 22% (CR 8%). The median follow-up of surviving patients in whom treatment failed was 10.6 months. Several factors predicting further treatment administration and outcomes were present even before CAR-Tx. Risk factors for not receiving further therapy after CAR-Tx failure were high lactate dehydrogenase (LDH) levels before apheresis, extranodal involvement (EN), high ferritin levels before lymphodepletion (LD) and ECOG PS >1 at R/P. The median OS-2 (from R/P after CAR-Tx) was 6.7 months (6-month 57.9%) for treated patients and 0.4 months (6-month 4.2%) for untreated patients (p < 0.001). The median PFS-2 (from R/P after CAR-Tx) was 3.2 months (6-month 28.5%) for treated patients. The risk factors for a shorter PFS-2 (n = 39) included: CRP > limit of the normal range (LNR) before LD, albumin < LNR and ECOG PS > 1 at R/P. All these factors, together with LDH > LNR before LD and EN involvement at R/P, predicted OS-2 for treated patients. CONCLUSION Our findings allow better stratification of CAR-Tx candidates and stress the need for a proactive approach (earlier restaging, intervention after partial remission achievement).
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MESH Headings
- Humans
- Male
- Female
- Middle Aged
- Immunotherapy, Adoptive/methods
- Aged
- Adult
- Lymphoma, Large B-Cell, Diffuse/therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/immunology
- Neoplasm Recurrence, Local
- Biological Products/therapeutic use
- Receptors, Chimeric Antigen/immunology
- Young Adult
- Risk Factors
- Czech Republic
- Aged, 80 and over
- Slovakia
- Treatment Outcome
- Antigens, CD19/immunology
- Progression-Free Survival
- Disease Progression
- Receptors, Antigen, T-Cell/genetics
- Receptors, Antigen, T-Cell/metabolism
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Affiliation(s)
- Alice Sýkorová
- 4th Department of Internal Medicine - Haematology, University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
| | - František Folber
- Department of Internal Medicine, Haematology and Oncology, Masaryk University Hospital, Brno, Czech Republic
| | - Kamila Polgárová
- 1st Department of Medicine-Department of Haematology, Charles University, General University Hospital, Prague, Czech Republic
| | - Heidi Móciková
- Department of Haematology, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Juraj Ďuraš
- Department of Haemato-oncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Kateřina Steinerová
- Department of Haematology and Oncology, University Hospital, Pilsen, Czech Republic
| | - Aleš Obr
- Department of Haemato-Oncology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | | | - Miriam Ladická
- Clinic of Oncohaematology, Medical Faculty of Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Ľubica Lukáčová
- Oncology Clinic, J.A. Reiman Faculty Hospital, Prešov, Slovakia
| | - Erika Čellárová
- Department of Haematology, F.D. Roosevelt University Hospital, Banská Bystrica, Slovakia
| | - Ivana Plameňová
- Clinic of Haematology and Transfusion Medicine, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - David Belada
- 4th Department of Internal Medicine - Haematology, University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
| | - Andrea Janíková
- Department of Internal Medicine, Haematology and Oncology, Masaryk University Hospital, Brno, Czech Republic
| | - Marek Trněný
- 1st Department of Medicine-Department of Haematology, Charles University, General University Hospital, Prague, Czech Republic
| | - Tereza Jančárková
- Department of Haematology, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vít Procházka
- Department of Haemato-Oncology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | - Andrej Vranovský
- Clinic of Oncohaematology, Medical Faculty of Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Margaréta Králiková
- Department of Haematology, F.D. Roosevelt University Hospital, Banská Bystrica, Slovakia
| | - Jan Vydra
- Institute of Haematology and Blood Transfusion, Prague, Czech Republic
| | - Lukáš Smolej
- 4th Department of Internal Medicine - Haematology, University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
| | - Ľuboš Drgoňa
- Clinic of Oncohaematology, Medical Faculty of Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Martin Sedmina
- Department of Haematology, F.D. Roosevelt University Hospital, Banská Bystrica, Slovakia
| | - Eva Čermáková
- Department of Medical Biophysics, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Robert Pytlík
- Institute of Haematology and Blood Transfusion, Prague, Czech Republic
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4
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Blumenberg V, Maus MV. Tracking non-relapse mortality after CAR T cell therapy. Nat Med 2024:10.1038/s41591-024-03212-2. [PMID: 39215151 DOI: 10.1038/s41591-024-03212-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Affiliation(s)
- Viktoria Blumenberg
- Cellular Immunotherapy Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Marcela V Maus
- Cellular Immunotherapy Program, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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5
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Mazetto RASV, Monteiro SON, Bulhões E, Defante MLR, Antunes VLJ, Balieiro CCA, Feitoza L, Ferreira ALC, Carvalho AM, Guida C. The cardiotoxic effects of CAR-T cell therapy: An updated systematic review and meta-analysis. Eur J Haematol 2024. [PMID: 39171519 DOI: 10.1111/ejh.14289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 07/20/2024] [Accepted: 07/25/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Chimeric antigen receptor T-cell (CAR-T) therapy has shown promise in treating hematologic malignancies, yet its potential cardiotoxic effects require thorough investigation. OBJECTIVES We aim to conduct a systematic review and meta-analysis to examine the cardiotoxic effects of CAR-T therapy in adults with hematologic malignancies. METHODS We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for studies reporting cardiovascular outcomes, such as arrhythmias, heart failure, and reduced left ventricle ejection fraction (LVEF). RESULTS Our analysis of 20 studies involving 4789 patients revealed a 19.68% incidence rate of cardiovascular events, with arrhythmias (7.70%), heart failure (5.73%), and reduced LVEF (3.86%) being the most prevalent. Troponin elevation was observed in 23.61% of patients, while NT-Pro-BNP elevation was observed in 9.4. Subgroup analysis showed higher risks in patients with pre-existing conditions, such as atrial arrhythmia (OR 3.12; p < .001), hypertension (OR 1.85; p = .002), previous heart failure (OR 3.38; p = .003), and coronary artery disease (OR 2.80; p = .003). CONCLUSION Vigilant cardiovascular monitoring is crucial for patients undergoing CAR-T therapy to enhance safety and treatment efficacy.Novelty Statements.
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Affiliation(s)
| | | | - Elísio Bulhões
- Medicine Department, Faculty of Higher Superior of the Amazon Reunida, Redenção, Brazil
| | | | - Vanio L J Antunes
- Medicine Department, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | | | - Luanna Feitoza
- Medicine Department, Fametro University Center, Manaus, Brazil
| | - André L C Ferreira
- Medicine Department, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Amadeu M Carvalho
- Medicine Department, Ribeirão Preto Medical School of University of São Paulo, Ribeirão Preto, Brazil
| | - Camila Guida
- Division of Cardiology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
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Sesques P, Kirkwood AA, Kwon M, Rejeski K, Jain MD, Di Blasi R, Brisou G, Gros FX, le Bras F, Bories P, Choquet S, Rubio MT, Iacoboni G, O'Reilly M, Casasnovas RO, Bay JO, Mohty M, Joris M, Abraham J, Castilla Llorente C, Loschi M, Carras S, Chauchet A, La Rochelle LD, Hermine O, Guidez S, Cony-Makhoul P, Fogarty P, Le Gouill S, Morschhauser F, Gastinne T, Cartron G, Subklewe M, Locke FL, Sanderson R, Barba P, Houot R, Bachy E. Novel prognostic scoring systems for severe CRS and ICANS after anti-CD19 CAR T cells in large B-cell lymphoma. J Hematol Oncol 2024; 17:61. [PMID: 39107847 PMCID: PMC11305039 DOI: 10.1186/s13045-024-01579-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 07/19/2024] [Indexed: 08/10/2024] Open
Abstract
Autologous anti-CD19 chimeric antigen receptor (CAR) T cells are now used in routine practice for relapsed/refractory (R/R) large B-cell lymphoma (LBCL). Severe (grade ≥ 3) cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity (ICANS) are still the most concerning acute toxicities leading to frequent intensive care unit (ICU) admission, prolonging hospitalization, and adding significant cost to treatment. We report on the incidence of CRS and ICANS and the outcomes in a large cohort of 925 patients with LBCL treated with axicabtagene ciloleucel (axi-cel) or tisagenlecleucel (tisa-cel) in France based on patient data captured through the DESCAR-T registry. CRS of any grade occurred in 778 patients (84.1%), with 74 patients (8.0%) with grade 3 CRS or higher, while ICANS of any grade occurred in 375 patients (40.5%), with 112 patients (12.1%) with grade ≥ 3 ICANS. Based on the parameters selected by multivariable analyses, two independent prognostic scoring systems (PSS) were derived, one for grade ≥ 3 CRS and one for grade ≥ 3 ICANS. CRS-PSS included bulky disease, a platelet count < 150 G/L, a C-reactive protein (CRP) level > 30 mg/L and no bridging therapy or stable or progressive disease (SD/PD) after bridging. Patients with a CRS-PSS score > 2 had significantly higher risk to develop grade ≥ 3 CRS. ICANS-PSS included female sex, low level of platelets (< 150 G/L), use of axi-cel and no bridging therapy or SD/PD after bridging. Patients with a CRS-PSS score > 2 had significantly higher risk to develop grade ≥ 3 ICANS. Both scores were externally validated in international cohorts of patients treated with tisa-cel or axi-cel.
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MESH Headings
- Humans
- Immunotherapy, Adoptive/adverse effects
- Immunotherapy, Adoptive/methods
- Male
- Female
- Middle Aged
- Antigens, CD19/immunology
- Prognosis
- Lymphoma, Large B-Cell, Diffuse/therapy
- Lymphoma, Large B-Cell, Diffuse/immunology
- Cytokine Release Syndrome/etiology
- Aged
- Adult
- Neurotoxicity Syndromes/etiology
- Biological Products/therapeutic use
- Biological Products/adverse effects
- France
- Aged, 80 and over
- Receptors, Antigen, T-Cell
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Affiliation(s)
- Pierre Sesques
- Hematology Department, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69410, Pierre Bénite, Lyon, France
| | - Amy A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
| | - Mi Kwon
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Kai Rejeski
- Department of Medicine III - Hematology/Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Michael D Jain
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, USA
| | | | - Gabriel Brisou
- Hematology Department, Institut Paoli Calmettes, Marseille, France
| | | | - Fabien le Bras
- Hematology Department, Hôpital Henri Mondor, Créteil, France
| | - Pierre Bories
- Hematology Department, CHU de Toulouse, Toulouse, France
| | - Sylvain Choquet
- Hematology Department, Hôpital de la Pitié Salpêtrière and AP-HP Sorbonne Université, Paris, France
| | | | - Gloria Iacoboni
- Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain
- Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Maeve O'Reilly
- Department of Haematology, University College London Hospitals, London, UK
| | | | | | - Mohamad Mohty
- Hematology Department, Hôpital Saint Antoine, Inserm UMRs 938, Sorbonne University, Paris, France
| | | | - Julie Abraham
- Hematology Department, CHU de Limoges, Limoges, France
| | | | | | - Sylvain Carras
- Hematology Department, Institute for Advanced Biosciences (INSERM U1209, CNRS UMR 5309), CHU de Grenoble and University Grenoble-Alpes, La Tronche, France
| | | | | | | | | | | | | | | | - Franck Morschhauser
- Hematology Department, CHU de Lille, Lille, France
- ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille University, Lille, France
| | | | - Guillaume Cartron
- Hematology Department, CHU de Montpellier and UMR-CNRS, Montpellier, France
| | - Marion Subklewe
- Department of Medicine III - Hematology/Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Frederick L Locke
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, USA
| | - Robin Sanderson
- Department of Haematology, King's College Hospital, London, UK
| | - Pere Barba
- Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain
- Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Roch Houot
- Hematology Department, CHU de Rennes, Rennes, France
| | - Emmanuel Bachy
- Hematology Department, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69410, Pierre Bénite, Lyon, France.
- Lymphoma Immuno-Biology, CIRI, Inserm U1111, Lyon, France.
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7
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Gong IY, Tran D, Saibil S, Laister RC, Kuruvilla J. Biomarkers of outcome in patients undergoing CD19 CAR-T therapy for large B cell lymphoma. Hemasphere 2024; 8:e130. [PMID: 39175824 PMCID: PMC11339649 DOI: 10.1002/hem3.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/12/2024] [Accepted: 06/26/2024] [Indexed: 08/24/2024] Open
Abstract
CD19-directed autologous chimeric antigen receptor T cell (CAR-T) therapy has transformed the management of relapsed/refractory (R/R) large B cell lymphoma (LBCL). Initially approved in the third line and beyond setting, CAR-T is now standard of care (SOC) for second-line treatment in patients with refractory disease or early relapse (progression within 12 months) following primary chemoimmunotherapy. Despite becoming SOC, most patients do not achieve complete response, and long-term cure is only observed in approximately 40% of patients. Accordingly, there is an urgent need to better understand the mechanisms of treatment failure and to identify patients that are unlikely to benefit from SOC CAR-T. The field needs robust biomarkers to predict treatment outcome, as better understanding of prognostic factors and mechanisms of resistance can inform on the design of novel treatment approaches for patients predicted to respond poorly to SOC CAR-T. This review aims to provide a comprehensive overview of clinical, molecular, imaging, and cellular features that have been shown to influence outcomes of CAR-T therapy in patients with R/R LBCL.
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Affiliation(s)
- Inna Y. Gong
- Princess Margaret Cancer CenterTorontoOntarioCanada
- Division of Medical Oncology and HematologyUniversity Health NetworkTorontoOntarioCanada
| | - Daisy Tran
- Princess Margaret Cancer CenterTorontoOntarioCanada
- Division of Medical Oncology and HematologyUniversity Health NetworkTorontoOntarioCanada
| | - Samuel Saibil
- Princess Margaret Cancer CenterTorontoOntarioCanada
- Division of Medical Oncology and HematologyUniversity Health NetworkTorontoOntarioCanada
- Department of ImmunologyUniversity of TorontoTorontoOntarioCanada
| | - Rob C. Laister
- Princess Margaret Cancer CenterTorontoOntarioCanada
- Division of Medical Oncology and HematologyUniversity Health NetworkTorontoOntarioCanada
| | - John Kuruvilla
- Princess Margaret Cancer CenterTorontoOntarioCanada
- Division of Medical Oncology and HematologyUniversity Health NetworkTorontoOntarioCanada
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8
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Pernas B, Iacoboni G, Los-Arcos I, Carpio C, Márquez-Algaba E, Sanchez-Salinas MA, Albasanz A, Esperalba J, Viñado B, Camps IR, Barba P. Patients with aggressive B-cell lymphoma receiving CAR T-cell therapy have a low rate of severe infections despite lack of universal antibacterial and antifungal prophylaxis. Eur J Haematol 2024; 113:227-234. [PMID: 38665060 DOI: 10.1111/ejh.14207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/18/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVES Our aim was to describe the frequency and severity of infectious complications after chimeric antigen receptor (CAR) T-cell therapy in patients with large B-cell lymphoma (LBCL). METHODS We retrospectively reviewed clinical records of LBCL patients treated with CD19-targeted CAR T-cell therapy from July/2018 to December/2021 at our institution, and identified all infectious episodes from CAR T-cell infusion until disease progression, death or last follow-up. RESULTS Overall, 137 patients were included. Thirty six percent had received ≥3 previous lines of therapy and 26% an autologous hematopoietic cell transplantation (auto-HCT). Cytokine release syndrome occurred in 87 (64%) patients. Antibacterial prophylaxis was not used in any patient; only 38% received antifungal prophylaxis. Sixty three infectious events were observed in 41 (30%) patients. Fifty two (83%) of the infectious events had at least one pathogen identified (bacteria [n = 38], virus [n = 11], and fungi [n = 3]). Most of the infectious events occurred during hospitalization for CAR-T treatment. Infection-related mortality was observed in two patients. Independent risk factors for infection included male gender, previous auto-HCT, ≥3 lines of treatment and pre-lymphodepletion neutropenia. CONCLUSIONS Infections after CAR T-cell therapy in patients with lymphoma are frequent but generally not severe. A conservative and tailored antimicrobial prophylaxis seems to be a safe approach.
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Affiliation(s)
- B Pernas
- Infectious Diseases Unit, Department of Internal Medicine, University Hospital of A Coruña, A Coruña, Spain
- Department of Infectious Diseases, University Hospital Vall d'Hebron, Barcelona, Spain
| | - G Iacoboni
- Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - I Los-Arcos
- Department of Infectious Diseases, University Hospital Vall d'Hebron, Barcelona, Spain
| | - C Carpio
- Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - E Márquez-Algaba
- Department of Infectious Diseases, University Hospital Vall d'Hebron, Barcelona, Spain
| | - M A Sanchez-Salinas
- Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - A Albasanz
- Department of Infectious Diseases, University Hospital Vall d'Hebron, Barcelona, Spain
| | - J Esperalba
- Department of Microbiology, University Hospital Vall d'Hebron, Barcelona, Spain
- CIBER of Infectious Diseases (CIBERINFEC), Carlos III Health Institute, Madrid, Spain
| | - B Viñado
- Department of Microbiology, University Hospital Vall d'Hebron, Barcelona, Spain
- CIBER of Infectious Diseases (CIBERINFEC), Carlos III Health Institute, Madrid, Spain
| | - I Ruiz Camps
- Department of Infectious Diseases, University Hospital Vall d'Hebron, Barcelona, Spain
- CIBER of Infectious Diseases (CIBERINFEC), Carlos III Health Institute, Madrid, Spain
| | - P Barba
- Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain
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9
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Kuhnl A, Roddie C, Kirkwood AA, Chaganti S, Norman J, Lugthart S, Osborne W, Gibb A, Gonzalez Arias C, Latif A, Uttenthal B, Seymour F, Jones C, Springell D, Brady JL, Illidge T, Stevens A, Alexander E, Hawley L, O'Rourke N, Bedi C, Prestwich R, Frew J, Burns D, O'Reilly M, Sanderson R, Sivabalasingham S, Mikhaeel NG. Outcome and feasibility of radiotherapy bridging in large B-cell lymphoma patients receiving CD19 CAR T in the UK. Br J Haematol 2024; 205:483-494. [PMID: 38594876 DOI: 10.1111/bjh.19453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/07/2024] [Accepted: 03/27/2024] [Indexed: 04/11/2024]
Abstract
Radiotherapy (RT) has potential synergistic effects with chimeric antigen receptor (CAR) T but is not widely used as bridging therapy due to logistical challenges and lack of standardised protocols. We analysed RT bridging in a multicentre national cohort of large B-cell lymphoma patients approved for 3L axicabtagene ciloleucel or tisagenlecleucel across 12 UK centres. Of 763 approved patients, 722 were leukapheresed, 717 had data available on bridging therapy. 169/717 (24%) received RT bridging, 129 as single modality and 40 as combined modality treatment (CMT). Of 169 patients, 65.7% had advanced stage, 36.9% bulky disease, 86.5% elevated LDH, 41.7% international prognostic index (IPI) ≥3 and 15.2% double/triple hit at the time of approval. Use of RT bridging varied from 11% to 32% between centres and increased over time. Vein-to-vein time and infusion rate did not differ between bridging modalities. RT-bridged patients had favourable outcomes with 1-year progression-free survival (PFS) of 56% for single modality and 47% for CMT (1-year PFS 43% for systemic bridging). This is the largest cohort of LBCL patients receiving RT bridging prior to CAR T reported to date. Our results show that RT bridging can be safely and effectively used even in advanced stage and high-risk disease, with low dropout rates and excellent outcomes.
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Affiliation(s)
- A Kuhnl
- Department of Haematology, King's College Hospital, London, UK
| | - C Roddie
- University College London Hospitals, London, UK
- UCL Cancer Institute, University College London, London, UK
| | - A A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, UCL, London, UK
| | - S Chaganti
- Queen Elizabeth Hospital, Birmingham, UK
| | - J Norman
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - S Lugthart
- University Hospitals Bristol and Weston, Bristol, UK
| | - W Osborne
- Freeman Hospital, Newcastle, UK
- Newcastle University, Newcastle, UK
| | - A Gibb
- Department of Medical Oncology, The Christie Hospital, Manchester, UK
| | | | - A Latif
- Queen Elizabeth University Hospital, Glasgow, UK
| | - B Uttenthal
- Department of Haematology, Addenbrooke's Hospital, Cambridge, UK
| | | | - C Jones
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - D Springell
- University College London Hospitals, London, UK
| | - J L Brady
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - T Illidge
- Cancer Sciences, University of Manchester Christie NHS Trust, Manchester NIHR BRC, Manchester, UK
| | - A Stevens
- Queen Elizabeth Hospital, Birmingham, UK
| | | | - L Hawley
- University Hospitals Bristol and Weston, Bristol, UK
| | - N O'Rourke
- Queen Elizabeth University Hospital, Glasgow, UK
| | - C Bedi
- Western General Hospital, Edinburgh, UK
| | | | - J Frew
- Freeman Hospital, Newcastle, UK
| | - D Burns
- Queen Elizabeth Hospital, Birmingham, UK
| | - M O'Reilly
- University College London Hospitals, London, UK
| | - R Sanderson
- Department of Haematology, King's College Hospital, London, UK
| | | | - N G Mikhaeel
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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10
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Bourlon C, Roddie C, Menne T, Norman J, O'Reilly M, Gibb A, Besley C, Chaganti S, Arias CG, Jones C, Dikair A, Allen S, Seymour F, Osborne W, Mathew A, Townsend W, Patten PEM, Thoulouli E, Abdulgawad A, Lugthart S, Sanderson R, Kirkwood AA, Kuhnl A. Outcomes after chimeric antigen receptor T-cell therapy across large B-cell lymphoma subtypes. Haematologica 2024; 109:2716-2720. [PMID: 38572567 PMCID: PMC11290504 DOI: 10.3324/haematol.2024.285010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024] Open
Abstract
Not available.
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Affiliation(s)
| | - Claire Roddie
- Department of Haematology, University College London Hospitals, London, UK; UCL Cancer Institute, University College London, London
| | - Tobias Menne
- Department of Haematology, Freeman Hospital, Newcastle University, Newcastle
| | - Jane Norman
- Department of Haematology, Manchester Royal Infirmary, Manchester
| | - Maeve O'Reilly
- Department of Haematology, University College London Hospitals, London
| | - Adam Gibb
- Department of Medical Oncology, The Christie Hospital, Manchester
| | - Caroline Besley
- Department of Haematology, University Hospitals Bristol and Weston, Bristol
| | | | | | - Ceri Jones
- Department of Haematology. University Hospital of Wales, Cardiff
| | - Abdalla Dikair
- Department of Haematology, Queen Elizabeth Hospital, Glasgow
| | - Sharon Allen
- Department of Haematology, Cambridge University Hospitals, Cambridge
| | | | - Wendy Osborne
- Department of Haematology, Freeman Hospital, Newcastle University, Newcastle
| | - Amrith Mathew
- Department of Haematology, Queen Elizabeth Hospital, Birmingham
| | - William Townsend
- Department of Haematology, University College London Hospitals, London
| | - Piers E M Patten
- Department of Haematology, King's College Hospital, London, UK; Comprehensive Cancer Centre, King's College London, London
| | - Eleni Thoulouli
- Department of Haematology, Manchester Royal Infirmary, Manchester
| | | | - Sanne Lugthart
- Department of Haematology, University Hospitals Bristol and Weston, Bristol
| | | | - Amy A Kirkwood
- CR UK and UCL Cancer Trials Centre, UCL Cancer Institute, UCL, London
| | - Andrea Kuhnl
- Department of Haematology, King's College Hospital, London.
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11
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Bailén R, Iacoboni G, Delgado J, López-Corral L, Hernani-Morales R, Ortiz-Maldonado V, Guerreiro M, Caballero AC, Guerra-Domínguez ML, Sánchez-Pina JM, Peña M, Torrent A, Pérez-Martínez A, Bastos-Oreiro M, Reguera-Ortega JL, Martín A, Hernandez-Boluda JC, Martínez-Cibrián N, Sanz J, Briones J, Henriquez HL, Calbacho M, Mussetti A, Sancho JM, Barba P, Kwon M. Anti-CD19 CAR-T Cell Therapy in Elderly Patients: Multicentric Real-World Experience from GETH-TC/GELTAMO. Transplant Cell Ther 2024:S2666-6367(24)00485-8. [PMID: 39069076 DOI: 10.1016/j.jtct.2024.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/30/2024]
Abstract
Chimeric antigen receptor (CAR)-T cell therapy is approved for the treatment of relapsed/refractory (R/R) large B cell lymphoma (LBCL). However, elderly patients might not be candidates for this therapy due to its toxicity, and criteria for candidate selection are lacking. Our aim was to analyze efficacy and toxicity results of CAR-T cell therapy in the population of patients 70 years and older as compared to those obtained in younger patients in the real-world setting. A multicentric retrospective study was performed including patients with R/R aggressive LBCL who received commercial CAR-T cell therapy with either tisagenlecleucel or axicabtagene ciloleucel within the Spanish Group of Hematopoietic Transplant and Cell Therapy/Spanish Group of Lymphomas and Autologous Transplant (GETH-TC/GELTAMO) centers between 2019 and 2023. As of August 2023, 442 adult patients with aggressive LBCL underwent apheresis for CAR-T cell therapy as third or subsequent line and follow-up data was collected. Of 412 infused patients, 71 (17%) were 70 years or older. Baseline characteristics, product selection, and characteristics at apheresis (including disease status, Ann Arbor stage, revised international prognosis index (R-IPI), bulky disease, lactate dehydrogenase [LDH] and ECOG [Eastern Cooperative Group performance status]) were comparable between groups. Median time from both approval to infusion and apheresis to infusion did not differ. No differences were found between groups in overall and complete response rates at 1 and 3 months. With a median follow-up of 12.2 months (range 1-44), 12-month progression-free survival (PFS) and overall survival (OS) were comparable between groups (35.2% in <70 years vs. 35.9% in ≥70 years (P = .938) and 51.1% and 52.1% (P = .885), respectively). Age ≥70 years did not affect PFS (hazard ratio (HR) 0.98, P = .941) and OS (HR 0.97, P = .890) in the univariate and multivariate analysis. Cytokine release syndrome (CRS) was observed in 82% of patients <70 years old and 84.5% in ≥ 70 years old (P = .408). Grade ≥3 CRS was more frequent in the older group (5% vs. 15%, P = .002). In the multivariate analysis, age ≥70 years was associated with an increased risk of grade ≥3 CRS (OR 3.7, P = .013). No differences were observed in terms of overall neurotoxicity (35% vs. 42%, P = .281) or grade ≥3 (12% vs. 17%, P = .33). The proportion of patients with infections, admission to the intensive care unit within the first month, and non-relapse mortality were similar between both groups. CAR-T cell therapy in patients older than 70 years showed similar efficacy to that observed in younger patients in the real-world setting. However, age ≥70 years was an independent risk factor for grades 3-4 CRS. The need for additional strategies to reduce toxicity in this population should be addressed in future studies.
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Affiliation(s)
- Rebeca Bailén
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Gloria Iacoboni
- Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.; Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Javier Delgado
- Department of Haematology, Hospital Universitario Virgen del Rocío, Institute of Biomedicine of Seville (IBiS/CSIC/CIBERONC), University of Seville, Seville, Spain
| | - Lucía López-Corral
- Department of Hematology, Hospital Clínico Universitario de Salamanca, IBSAL, Salamanca, Spain
| | - Rafael Hernani-Morales
- Department of Hematology, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | | | - Manuel Guerreiro
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - María Luisa Guerra-Domínguez
- Department of Hematology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | | | - Marta Peña
- Department of Hematology, Hospital Duran i Reynals, Instituto Catalán de Oncología, IDIBELL, Barcelona, Spain
| | - Anna Torrent
- Department of Hematology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Mariana Bastos-Oreiro
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Gregorio Marañón Health Research Institute, Madrid, Spain.; Universidad Complutense de Madrid, Spain
| | - Juan Luis Reguera-Ortega
- Department of Haematology, Hospital Universitario Virgen del Rocío, Institute of Biomedicine of Seville (IBiS/CSIC/CIBERONC), University of Seville, Seville, Spain
| | - Alejandro Martín
- Department of Hematology, Hospital Clínico Universitario de Salamanca, IBSAL, Salamanca, Spain
| | - Juan Carlos Hernandez-Boluda
- Department of Hematology, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | | | - Jaime Sanz
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Javier Briones
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Hugo Luzardo Henriquez
- Department of Hematology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - María Calbacho
- Department of Hematology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Alberto Mussetti
- Department of Hematology, Hospital Duran i Reynals, Instituto Catalán de Oncología, IDIBELL, Barcelona, Spain
| | - Juan Manuel Sancho
- Department of Hematology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Pere Barba
- Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.; Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Mi Kwon
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Gregorio Marañón Health Research Institute, Madrid, Spain.; Universidad Complutense de Madrid, Spain..
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12
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Liu J, Xu M, Zhang X, Zhang Z, Zhong T, Yu H, Fu Y, Meng H, Feng J, Zou X, Han X, Kang L, Yu L, Li L. CD19 chimeric antigen receptor-T cells as bridging therapy to allogeneic hematopoietic cell transplantation improves outcome in patients with refractory/relapsed B-cell acute lymphoblastic leukemia. Heliyon 2024; 10:e33937. [PMID: 39055833 PMCID: PMC11269827 DOI: 10.1016/j.heliyon.2024.e33937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 06/30/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
Chimeric antigen receptor (CAR)-T cell therapy has been confirmed improving remission rates in refractory patients or relapsed B-cell acute lymphoblastic leukemia (R/R B-ALL). However, the added benefits of undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) following CAR-T therapy remain a subject of debate. In this research we investigated the efficiency and long-term outcomes of CD19 CAR-T bridging with allo-HSCT in R/R B-ALL patients. A total of 42 patients were brought into the cohort studies. Our findings revealed that patients who appected CAR-T followed by HSCT had a 1-year overall survival (OS) rate of 70 % and a 1-year leukemia-free survival (LFS) rate of 95 %. Moreover, patients who underwent this combined treatment had higher OS and LFS rates compared to those who received CAR-T therapy alone. In conclusion, the results of this clinical trial provide compelling evidence for the safety and efficacy of using CAR-T therapy as a bridging strategy to allo-HSCT in patients with R/R B-ALL.
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Affiliation(s)
- Jie Liu
- Department of Hematology, The First Affiliated Hospital, Harbin Medical University, The Institute of the Hematology and Oncology of Heilongjiang Province, Harbin, Heilongjiang, PR China
| | - Mengyuan Xu
- Department of Hematology, South University of Science and Technology Hospital, Shenzhen, Guangdong, PR China
| | - Xiaoqian Zhang
- Department of Hematology, South University of Science and Technology Hospital, Shenzhen, Guangdong, PR China
| | - Zhuo Zhang
- Department of Hematology, South University of Science and Technology Hospital, Shenzhen, Guangdong, PR China
| | - Tao Zhong
- Department of Hematology, South University of Science and Technology Hospital, Shenzhen, Guangdong, PR China
| | - Hongjuan Yu
- Department of Hematology, The First Affiliated Hospital, Harbin Medical University, The Institute of the Hematology and Oncology of Heilongjiang Province, Harbin, Heilongjiang, PR China
| | - Yueyue Fu
- Department of Hematology, The First Affiliated Hospital, Harbin Medical University, The Institute of the Hematology and Oncology of Heilongjiang Province, Harbin, Heilongjiang, PR China
| | - Hongbin Meng
- Department of Hematology, The First Affiliated Hospital, Harbin Medical University, The Institute of the Hematology and Oncology of Heilongjiang Province, Harbin, Heilongjiang, PR China
| | - Jiawei Feng
- Department of Hematology, South University of Science and Technology Hospital, Shenzhen, Guangdong, PR China
| | - Xindi Zou
- Department of Hematology, South University of Science and Technology Hospital, Shenzhen, Guangdong, PR China
| | - Xueying Han
- Department of Hematology, South University of Science and Technology Hospital, Shenzhen, Guangdong, PR China
| | - Liqing Kang
- Shanghai Unicar-Therapy Bio-medicine Technology Co., Ltd, Shanghai, PR China
| | - Lei Yu
- Shanghai Unicar-Therapy Bio-medicine Technology Co., Ltd, Shanghai, PR China
| | - Limin Li
- Department of Hematology, South University of Science and Technology Hospital, Shenzhen, Guangdong, PR China
- Department of Hematology, The First Affiliated Hospital, Harbin Medical University, The Institute of the Hematology and Oncology of Heilongjiang Province, Harbin, Heilongjiang, PR China
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13
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Zhong Y, Liu J. Emerging roles of CAR-NK cell therapies in tumor immunotherapy: current status and future directions. Cell Death Discov 2024; 10:318. [PMID: 38987565 PMCID: PMC11236993 DOI: 10.1038/s41420-024-02077-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 06/12/2024] [Accepted: 06/18/2024] [Indexed: 07/12/2024] Open
Abstract
Cancer immunotherapy harnesses the body's immune system to combat malignancies, building upon an understanding of tumor immunosurveillance and immune evasion mechanisms. This therapeutic approach reactivates anti-tumor immune responses and can be categorized into active, passive, and combined immunization strategies. Active immunotherapy engages the immune system to recognize and attack tumor cells by leveraging host immunity with cytokine supplementation or vaccination. Conversely, passive immunotherapy employs exogenous agents, such as monoclonal antibodies (anti-CTLA4, anti-PD1, anti-PD-L1) or adoptive cell transfers (ACT) with genetically engineered chimeric antigen receptor (CAR) T or NK cells, to exert anti-tumor effects. Over the past decades, CAR-T cell therapies have gained significant traction in oncological treatment, offering hope through their targeted approach. However, the potential adverse effects associated with CAR-T cells, including cytokine release syndrome (CRS), off-tumor toxicity, and neurotoxicity, warrant careful consideration. Recently, CAR-NK cell therapy has emerged as a promising alternative in the landscape of tumor immunotherapy, distinguished by its innate advantages over CAR-T cell modalities. In this review, we will synthesize the latest research and clinical advancements in CAR-NK cell therapies. We will elucidate the therapeutic benefits of employing CAR-NK cells in oncology and critically examine the developmental bottlenecks impeding their broader application. Our discussion aims to provide a comprehensive overview of the current status and future potential of CAR-NK cells in cancer immunotherapy.
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Affiliation(s)
- Yan Zhong
- Department of Pathology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Jingfeng Liu
- Shenzhen Key Laboratory of Immunity and Inflammatory Diseases, Peking University Shenzhen Hospital, Shenzhen, China.
- Institute of Biomedicine and Biotechnology, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen, China.
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14
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Vadgama S, Pasquini MC, Maziarz RT, Hu ZH, Ray M, Smith H, Bullement A, Edmondson-Jones M, Sullivan W, Cartron G. "Don't keep me waiting": estimating the impact of reduced vein-to-vein time on lifetime US 3L+ LBCL patient outcomes. Blood Adv 2024; 8:3519-3527. [PMID: 38662645 PMCID: PMC11261112 DOI: 10.1182/bloodadvances.2023012240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 05/01/2024] Open
Abstract
ABSTRACT Chimeric antigen receptor T-cell therapy (CAR T) has revolutionized the treatment of hematological cancers. Its production requires a complex logistical process, and the time from leukapheresis to patient infusion (known as the vein-to-vein time [V2VT]) can be long during which a patients clinical condition may deteriorate. This study was designed to estimate the benefits of reduced V2VT for third-line or later (3L+) relapsed/refractory large B-cell lymphoma (R/R LBCL) patients treated with CAR T. A mathematical model was developed to estimate the lifetime outcomes of a hypothetical cohort of patients who had either a long or short V2VT. Life-years (LYs), quality-adjusted LYs (QALYs), and costs were estimated. Scenario analyses were performed to assess the robustness of results to key assumptions. The results of the model show that reducing V2VT from 54 days (tisa-cel median V2VT; JULIET) to 24 days (axi-cel median V2VT; ZUMA-1) led to a 3.2-year gain in life expectancy (4.2 vs 7.7 LYs), and 2.4 additional QALYs (3.2 vs 5.6) per patient. Furthermore, a shorter V2VT was shown to be cost-effective under conventional willingness-to-pay thresholds in the United States. Results are driven by a higher infusion rate and a better efficacy of CAR T for those infused. Scenario analyses using a smaller difference in V2VT (24 vs 36 days) produced consistent results. Our study is the first to quantify lifetime V2VT-related outcomes for 3L+ R/R LBCL patients treated with CAR T utilizing currently available evidence. Shorter V2VTs led to improved outcomes, demonstrating the importance of timely infusion achievable by faster manufacturing times and optimization of hospital delivery.
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Affiliation(s)
| | - Marcelo C. Pasquini
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin Cancer Center, Milwaukee, WI
| | | | | | | | - Harry Smith
- Kite, A Gilead company, Uxbridge, United Kingdom
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15
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Cordas Dos Santos DM, Tix T, Shouval R, Gafter-Gvili A, Alberge JB, Cliff ERS, Theurich S, von Bergwelt-Baildon M, Ghobrial IM, Subklewe M, Perales MA, Rejeski K. A systematic review and meta-analysis of nonrelapse mortality after CAR T cell therapy. Nat Med 2024:10.1038/s41591-024-03084-6. [PMID: 38977912 DOI: 10.1038/s41591-024-03084-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/22/2024] [Indexed: 07/10/2024]
Abstract
Although chimeric antigen receptor (CAR) T cell therapy represents a transformative immunotherapy, it is also associated with distinct toxicities that contribute to morbidity and mortality. In this systematic review and meta-analysis, we searched MEDLINE, Embase and CINAHL (Cochrane) for reports of nonrelapse mortality (NRM) after CAR T cell therapy in lymphoma and multiple myeloma up to March 2024. After extraction of causes and numbers of death, we analyzed NRM point estimates using random-effect models. We identified 7,604 patients across 18 clinical trials and 28 real-world studies. NRM point estimates varied across disease entities and were highest in patients with mantle-cell lymphoma (10.6%), followed by multiple myeloma (8.0%), large B cell lymphoma (6.1%) and indolent lymphoma (5.7%). Entity-specific meta-regression models for large B cell lymphoma and multiple myeloma revealed that axicabtagene ciloleucel and ciltacabtagene autoleucel were independently associated with increased NRM point estimates, respectively. Of 574 reported nonrelapse deaths, over half were attributed to infections (50.9%), followed by other malignancies (7.8%) and cardiovascular/respiratory events (7.3%). Conversely, the CAR T cell-specific side effects, immune effector cell-associated neurotoxicity syndrome/neurotoxicity, cytokine release syndrome and hemophagocytic lymphohistiocytosis, represented only a minority of nonrelapse deaths (cumulatively 11.5%). Our findings underline the critical importance of infectious complications after CAR T cell therapy and support the comprehensive reporting of NRM, including specific causes and long-term outcomes.
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Affiliation(s)
- David M Cordas Dos Santos
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Department of Medicine III-Hematology/Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Tobias Tix
- Department of Medicine III-Hematology/Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Roni Shouval
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Anat Gafter-Gvili
- Department of Medicine A and Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Jean-Baptiste Alberge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Edward R Scheffer Cliff
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Program on Regulation, Therapeutics and Law, Brigham and Women's Hospital, Boston, MA, USA
| | - Sebastian Theurich
- Department of Medicine III-Hematology/Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium, Partner Site Munich, Munich, Germany
| | - Michael von Bergwelt-Baildon
- Department of Medicine III-Hematology/Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium, Partner Site Munich, Munich, Germany
| | - Irene M Ghobrial
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Marion Subklewe
- Department of Medicine III-Hematology/Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium, Partner Site Munich, Munich, Germany
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Kai Rejeski
- Department of Medicine III-Hematology/Oncology, LMU University Hospital, LMU Munich, Munich, Germany.
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
- German Cancer Consortium, Partner Site Munich, Munich, Germany.
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16
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Bharadwaj S, Lau E, Hamilton MP, Goyal A, Srinagesh H, Jensen A, Lee D, Mallampet J, Elkordy S, Syal S, Patil S, Latchford T, Sahaf B, Arai S, Johnston LJ, Lowsky R, Negrin R, Rezvani AR, Shizuru J, Meyer EH, Shiraz P, Mikkilineni L, Weng WK, Smith M, Sidana S, Muffly L, Maecker HT, Frank MJ, Mackall C, Miklos D, Dahiya S. Bendamustine is a safe and effective lymphodepletion agent for axicabtagene ciloleucel in patients with refractory or relapsed large B-cell lymphoma. J Immunother Cancer 2024; 12:e008975. [PMID: 38955420 PMCID: PMC11218002 DOI: 10.1136/jitc-2024-008975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Fludarabine in combination with cyclophosphamide (FC) is the standard lymphodepletion regimen for CAR T-cell therapy (CAR T). A national fludarabine shortage in 2022 necessitated the exploration of alternative regimens with many centers employing single-agent bendamustine as lymphodepletion despite a lack of clinical safety and efficacy data. To fill this gap in the literature, we evaluated the safety, efficacy, and expansion kinetics of bendamustine as lymphodepletion prior to axicabtagene ciloleucel (axi-cel) therapy. METHODS 84 consecutive patients with relapsed or refractory large B-cell lymphoma treated with axi-cel and managed with a uniform toxicity management plan at Stanford University were studied. 27 patients received alternative lymphodepletion with bendamustine while 57 received FC. RESULTS Best complete response rates were similar (73.7% for FC and 74% for bendamustine, p=0.28) and there was no significant difference in 12-month progression-free survival or overall survival estimates (p=0.17 and p=0.62, respectively). The frequency of high-grade cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome was similar in both the cohorts. Bendamustine cohort experienced lower proportions of hematological toxicities and antibiotic use for neutropenic fever. Immune reconstitution, as measured by quantitative assessment of cellular immunity, was better in bendamustine cohort as compared with FC cohort. CAR T expansion as measured by peak expansion and area under the curve for expansion was comparable between cohorts. CONCLUSIONS Bendamustine is a safe and effective alternative lymphodepletion conditioning for axi-cel with lower early hematological toxicity and favorable immune reconstitution.
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Affiliation(s)
- Sushma Bharadwaj
- Stanford University School of Medicine, Stanford, California, USA
| | - Eric Lau
- Stanford University School of Medicine, Stanford, California, USA
| | - Mark P Hamilton
- Stanford University School of Medicine, Stanford, California, USA
| | - Anmol Goyal
- Stanford University School of Medicine, Stanford, California, USA
| | - Hrishi Srinagesh
- Stanford University School of Medicine, Stanford, California, USA
| | | | - Dasom Lee
- Stanford University School of Medicine, Stanford, California, USA
| | - Jayasindhu Mallampet
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California, USA
| | - Sarah Elkordy
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California, USA
| | - Shriya Syal
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California, USA
| | - Sunita Patil
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California, USA
| | | | - Bita Sahaf
- Cancer Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Sally Arai
- Stanford University School of Medicine, Stanford, California, USA
| | - Laura J Johnston
- Stanford University School of Medicine, Stanford, California, USA
| | - Robert Lowsky
- Stanford University School of Medicine, Stanford, California, USA
| | | | - Andrew R Rezvani
- Stanford University School of Medicine, Stanford, California, USA
| | | | - Everett H Meyer
- Stanford University School of Medicine, Stanford, California, USA
| | - Parveen Shiraz
- Stanford University School of Medicine, Stanford, California, USA
| | | | - Wen-Kai Weng
- Stanford University School of Medicine, Stanford, California, USA
| | - Melody Smith
- Stanford University School of Medicine, Stanford, California, USA
| | - Surbhi Sidana
- Stanford University School of Medicine, Stanford, California, USA
| | - Lori Muffly
- Stanford University, Palo Alto, California, USA
| | | | - Matthew J Frank
- Stanford University School of Medicine, Stanford, California, USA
| | | | | | - Saurabh Dahiya
- Stanford University School of Medicine, Stanford, California, USA
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17
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Yu L, Zou R, He J, Qu C. Role of radiation in chimeric antigen receptor T-cell therapy for patients with relapsed/refractory non-Hodgkin lymphoma: Current studies and future prospects. Crit Rev Oncol Hematol 2024; 199:104390. [PMID: 38782146 DOI: 10.1016/j.critrevonc.2024.104390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
Chimeric antigen receptor T-cell (CAR-T) therapy has revolutionized the treatment approach for patients with relapsed/refractory non-Hodgkin lymphoma (R/R NHL). However, the long-term prognosis has been discouraging. Moreover, the urgent resolution of two critical issues is necessary: minimize tumor burden before CAR-T infusion and control fatal toxicities post CAR-T therapy. By combining radiotherapy (RT), the safety and efficacy of CAR-T can be improved. RT can serve as bridging therapy, reducing the tumor burden before CAR-T infusion, thus enabling safe and successful CAR-T infusion, and as salvage therapy in cases of CAR-T therapy failure. This review aims to discuss the current evidence supporting the use of RT in CAR-T therapy for patients with R/R NHL. Although most studies have shown a positive role of RT in combined modality treatments for patients undergoing CAR-T therapy, the synergy gained from these remains uncertain. Furthermore, the optimal dose/fraction and radiation response require further investigation.
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Affiliation(s)
- Lingzi Yu
- Department of Hematology, the First Affiliated Hospital of Soochow University, and Jiangsu Institute of Hematology, Suzhou 215000, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou 215000, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou 215000, China.
| | - Rui Zou
- Department of Hematology, the First Affiliated Hospital of Soochow University, and Jiangsu Institute of Hematology, Suzhou 215000, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou 215000, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou 215000, China.
| | - Jiajie He
- Department of Hematology, the First Affiliated Hospital of Soochow University, and Jiangsu Institute of Hematology, Suzhou 215000, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou 215000, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou 215000, China.
| | - Changju Qu
- Department of Hematology, the First Affiliated Hospital of Soochow University, and Jiangsu Institute of Hematology, Suzhou 215000, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou 215000, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou 215000, China.
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18
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Hernani R, Aiko M, Victorio R, Benzaquén A, Pérez A, Piñana JL, Hernández-Boluda JC, Amat P, Pastor-Galán I, Remigia MJ, Ferrer-Lores B, Micó M, Carbonell N, Ferreres J, Blasco-Cortés ML, Santonja JM, Dosdá R, Estellés R, Campos S, Martínez-Ciarpaglini C, Ferrández-Izquierdo A, Goterris R, Gómez M, Teruel A, Saus A, Ortiz A, Morello D, Martí E, Carretero C, Calabuig M, Tormo M, Terol MJ, Cases P, Solano C. EEG before chimeric antigen receptor T-cell therapy and early after onset of immune effector cell-associated neurotoxicity syndrome. Clin Neurophysiol 2024; 163:132-142. [PMID: 38733703 DOI: 10.1016/j.clinph.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/24/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Immune effector cell-associated neurotoxicity syndrome (ICANS) is common after chimeric antigen receptor T-cell (CAR-T) therapy. OBJECTIVE This study aimed to assess the impact of preinfusion electroencephalography (EEG) abnormalities and EEG findings at ICANS onset for predicting ICANS risk and severity in 56 adult patients with refractory lymphoma undergoing CAR-T therapy. STUDY DESIGN EEGs were conducted at the time of lymphodepleting chemotherapy and shortly after onset of ICANS. RESULTS Twenty-eight (50%) patients developed ICANS at a median time of 6 days after CAR-T infusion. Abnormal preinfusion EEG was identified as a risk factor for severe ICANS (50% vs. 17%, P = 0.036). Following ICANS onset, EEG abnormalities were detected in 89% of patients [encephalopathy (n = 19, 70%) and/or interictal epileptiform discharges (IEDs) (n = 14, 52%)]. Importantly, IEDs seemed to be associated with rapid progression to higher grades of ICANS within 24 h. CONCLUSIONS If confirmed in a large cohort of patients, these findings could establish the basis for modifying current management guidelines, enabling the identification of patients at risk of neurotoxicity, and providing support for preemptive corticosteroid use in patients with both initial grade 1 ICANS and IEDs at neurotoxicity onset, who are at risk of neurological impairment.
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Affiliation(s)
- Rafael Hernani
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain.
| | - Mika Aiko
- Neurophysiology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Ruth Victorio
- Neurophysiology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Ana Benzaquén
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Ariadna Pérez
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - José Luis Piñana
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Juan Carlos Hernández-Boluda
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain
| | - Paula Amat
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain
| | - Irene Pastor-Galán
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - María José Remigia
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Blanca Ferrer-Lores
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Mireia Micó
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Nieves Carbonell
- Intensive Care Unit, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - José Ferreres
- Intensive Care Unit, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | | | - José Miguel Santonja
- Neurology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Rosa Dosdá
- Radiology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Rocío Estellés
- Radiology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Salvador Campos
- Radiology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | | | | | - Rosa Goterris
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Montse Gómez
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Anabel Teruel
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain
| | - Ana Saus
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Alfonso Ortiz
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Daniela Morello
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Edel Martí
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Carlos Carretero
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Marisa Calabuig
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Mar Tormo
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain
| | - María José Terol
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain
| | - Paula Cases
- Neurophysiology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Carlos Solano
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain
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19
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Iacoboni G, Sánchez‐Salinas MA, Rejeski K, Martín‐López AÁ, Kwon M, Navarro V, Jalowiec KA, Hernani R, Reguera‐Ortega JL, Gallur L, Blumenberg V, Herrero‐García M, Roddie C, Benzaquén A, Delgado‐Serrano J, Bailén R, Carpio C, Amat P, López‐Corral L, Martín‐Martín L, Bastos M, Subklewe M, O'Reilly M, Barba P. Efficacy and safety of bendamustine-containing bridging therapy in R/R LBCL patients receiving CD19 CAR T-cells. Hemasphere 2024; 8:e86. [PMID: 38948924 PMCID: PMC11208722 DOI: 10.1002/hem3.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 07/02/2024] Open
Abstract
Bridging therapy (BT) after leukapheresis is required in most relapsed/refractory (R/R) large B-cell lymphoma (LBCL) patients receiving chimeric antigen receptor (CAR) T cells. Bendamustine-containing regimens are a potential BT option. We aimed to assess if this agent had a negative impact on CAR-T outcomes when it was administered as BT. We included R/R LBCL patients from six centers who received systemic BT after leukapheresis from February 2019 to September 2022; patients who only received steroids or had pre-apheresis bendamustine exposure were excluded. Patients were divided into two BT groups, with and without bendamustine. Separate safety and efficacy analyses were carried out for axi-cel and tisa-cel. Of 243 patients who received BT, bendamustine (benda) was included in 62 (26%). There was a higher rate of BT progressors in the non-benda group (62% vs. 45%, p = 0.02). Concerning CAR-T efficacy, complete responses were comparable for benda versus non-benda BT cohorts with axi-cel (70% vs. 53%, p = 0.12) and tisa-cel (44% vs. 36%, p = 0.70). Also, 12-month progression-free and overall survival were not significantly different between BT groups with axi-cel (56% vs. 43% and 71% vs. 63%) and tisa-cel (25% vs. 26% and 52% vs. 48%); there were no differences when BT response was considered. CAR T-cell expansion for each construct was similar between BT groups. Regarding safety, CRS G ≥3 (6% vs. 6%, p = 0.79), ICANS G ≥3 (15% vs. 17%, p = 0.68), severe infections, and neutropenia post-infusion were comparable among BT regimens. BT with bendamustine-containing regimens is safe for patients requiring disease control during CAR T-cell manufacturing.
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Affiliation(s)
- Gloria Iacoboni
- Department of HematologyUniversity Hospital Vall d'HebronBarcelonaSpain
- Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO)BarcelonaSpain
- Department of MedicineUniversitat Autònoma de BarcelonaBellaterraSpain
| | - Mario A. Sánchez‐Salinas
- Department of HematologyUniversity Hospital Vall d'HebronBarcelonaSpain
- Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO)BarcelonaSpain
- Department of MedicineUniversitat Autònoma de BarcelonaBellaterraSpain
| | - Kai Rejeski
- Department of Medicine IIIUniversity Hospital, LMU MunichMunichGermany
- Laboratory for Translational Cancer ImmunologyGene Center of the LMU MunichMunichGermany
- Adult BMT and Cellular Therapy ServiceMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Ana Á. Martín‐López
- Hematology DepartmentHospital Clínico Universitario de Salamanca, IBSAL, CIBERONCSalamancaSpain
- Centro de Investigación del Cáncer‐IBMCCSalamancaSpain
| | - Mi Kwon
- Department of HematologyHospital General Universitario Gregorio MarañónMadridSpain
- Gregorio Marañón Health Research Institute (IiSGM)MadridSpain
| | - Víctor Navarro
- Oncology Data Science (ODySey) Group, Vall d'Hebron Institute of Oncology (VHIO)BarcelonaSpain
| | - Katarzyna A. Jalowiec
- Hematology DepartmentUniversity College London Cancer InstituteLondonUnited Kingdom
- Department of Hematology and Central Hematology LaboratoryUniversity Hospital of BernBernSwitzerland
| | - Rafael Hernani
- Haematology DepartmentHospital Clínico UniversitarioValenciaSpain
- INCLIVA Research InstituteValenciaSpain
| | - Juan L. Reguera‐Ortega
- Hematology Department, Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSICUniversidad de SevillaSevillaSpain
| | - Laura Gallur
- Department of HematologyUniversity Hospital Vall d'HebronBarcelonaSpain
- Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO)BarcelonaSpain
- Department of MedicineUniversitat Autònoma de BarcelonaBellaterraSpain
| | - Viktoria Blumenberg
- Department of Medicine IIIUniversity Hospital, LMU MunichMunichGermany
- Laboratory for Translational Cancer ImmunologyGene Center of the LMU MunichMunichGermany
| | - María Herrero‐García
- Cancer Research Centre (IBMCC, USAL‐CSIC), Institute for Biomedical Research of Salamanca (IBSAL) and Department of Medicine and Cytometry Service (NUCLEUS Research Support Platform)University of Salamanca (USAL)SalamancaSpain
| | - Claire Roddie
- Hematology DepartmentUniversity College London Cancer InstituteLondonUnited Kingdom
| | - Ana Benzaquén
- Haematology DepartmentHospital Clínico UniversitarioValenciaSpain
- INCLIVA Research InstituteValenciaSpain
| | - Javier Delgado‐Serrano
- Hematology Department, Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSICUniversidad de SevillaSevillaSpain
| | - Rebeca Bailén
- Department of HematologyHospital General Universitario Gregorio MarañónMadridSpain
- Gregorio Marañón Health Research Institute (IiSGM)MadridSpain
| | - Cecilia Carpio
- Department of HematologyUniversity Hospital Vall d'HebronBarcelonaSpain
- Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO)BarcelonaSpain
- Department of MedicineUniversitat Autònoma de BarcelonaBellaterraSpain
| | - Paula Amat
- Haematology DepartmentHospital Clínico UniversitarioValenciaSpain
- INCLIVA Research InstituteValenciaSpain
| | - Lucia López‐Corral
- Hematology DepartmentHospital Clínico Universitario de Salamanca, IBSAL, CIBERONCSalamancaSpain
- Centro de Investigación del Cáncer‐IBMCCSalamancaSpain
| | - Lourdes Martín‐Martín
- Cancer Research Centre (IBMCC, USAL‐CSIC), Institute for Biomedical Research of Salamanca (IBSAL) and Department of Medicine and Cytometry Service (NUCLEUS Research Support Platform)University of Salamanca (USAL)SalamancaSpain
| | - Mariana Bastos
- Department of HematologyHospital General Universitario Gregorio MarañónMadridSpain
- Gregorio Marañón Health Research Institute (IiSGM)MadridSpain
| | - Marion Subklewe
- Department of Medicine IIIUniversity Hospital, LMU MunichMunichGermany
- Laboratory for Translational Cancer ImmunologyGene Center of the LMU MunichMunichGermany
| | - Maeve O'Reilly
- Hematology DepartmentUniversity College London Cancer InstituteLondonUnited Kingdom
| | - Pere Barba
- Department of HematologyUniversity Hospital Vall d'HebronBarcelonaSpain
- Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO)BarcelonaSpain
- Department of MedicineUniversitat Autònoma de BarcelonaBellaterraSpain
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20
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Gagelmann N, Bishop M, Ayuk F, Bethge W, Glass B, Sureda A, Pasquini MC, Kröger N. Axicabtagene Ciloleucel versus Tisagenlecleucel for Relapsed or Refractory Large B Cell Lymphoma: A Systematic Review and Meta-Analysis. Transplant Cell Ther 2024; 30:584.e1-584.e13. [PMID: 38281590 DOI: 10.1016/j.jtct.2024.01.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/28/2023] [Accepted: 01/23/2024] [Indexed: 01/30/2024]
Abstract
Axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel) are CD19-directed chimeric antigen receptor T cell (CAR-T) therapies approved for relapsed/refractory aggressive large B cell lymphoma (LBCL). Significant costs and complex manufacturing underscore the importance of evidence-based counseling regarding the outcomes of these treatments. With the aim of examining the efficacy and safety of axi-cel versus tisa-cel in patients with relapsed/refractory aggressive LBCL, we performed a systematic literature search of comparative studies evaluating outcomes in relapsed/refractory aggressive LBCL after treatment with axi-cel or tisa-cel. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for response, progression-free survival (PFS), overall survival (OS), cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and hematotoxicity. Meta-analysis and meta-regression were used to generate summary statistics. A total of 2372 participants were included in the 8 studies in our analysis. The dropout rate between apheresis and infusion was 13% for axi-cel versus 18% for tisa-cel, and the median time from apheresis to infusion was 32 days versus 45 days. Axi-cel showed higher odds for a complete response (OR, 1.65; P < .001) and was associated with higher odds for PFS at 1 year after infusion (OR, .60; P < .001). OS appeared to be improved with axi-cel (OR, .84; 95% CI, .68 to 1.02; P = .08), whereas the cumulative incidence of nonrelapse mortality (NRM) was 11.5% for axi-cel versus 3.7% for tisa-cel (P = .002). The main predictors for survival were lactate dehydrogenase level, Eastern Cooperative Oncology Group Performance Status, and response to bridging, and axi-cel maintained superior efficacy even in elderly patients. In terms of safety, axi-cel was associated with significantly higher odds of any-grade CRS (OR, 3.23; P < .001), but not of grade ≥3 CRS (P = .92). Axi-cel was associated with significantly higher odds of severe ICANS grade ≥3 (OR, 4.03; P < .001). In terms of hematotoxicity, axi-cel was significantly associated with higher odds of severe neutropenia at 1 month after infusion (OR, 2.06; P = .003). As a result, axi-cel was associated with significantly greater resource utilization, including prolonged hospital stay, more frequent intensive care admission, and use of agents such as tocilizumab for toxicity management. We provide strong evidence of the greater efficacy of axi-cel versus tisa-cel in relapsed/refractory aggressive LBCL. The higher toxicity and NRM seen with axi-cel might not counterbalance the overall results, highlighting the need for timely intervention and careful selection of patients, balancing resource utilization and clinical benefit.
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Affiliation(s)
- Nico Gagelmann
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Michael Bishop
- The David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, Illinois
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Bethge
- Department of Hematology and Oncology, University Hospital Tuebingen, Tuebingen, Germany
| | - Bertram Glass
- Department of Hematology and Cell Therapy, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Anna Sureda
- Bellvitge Institute for Biomedical Research, Universitat de Barcelona, Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - Marcelo C Pasquini
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Yamshon S, Gribbin C, Alhomoud M, Chokr N, Chen Z, Demetres M, Pasciolla M, Leonard J, Shore T, Martin P. Safety and Toxicity Profiles of CAR T Cell Therapy in Non-Hodgkin Lymphoma: A Systematic Review and Meta-Analysis. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:e235-e256.e2. [PMID: 38582666 DOI: 10.1016/j.clml.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND The application of CD19-directed chimeric antigen receptor T (CAR T) cell therapy has improved outcomes for thousands of patients with non-Hodgkin B cell lymphoma (NHL). The toxicities associated with various CAR T cell products, however, can be severe and difficult to anticipate. METHODS In this systematic review and meta-analysis, we set out to determine whether there are measurable differences in common toxicities, including cytokine release syndrome (CRS), immune effector cell associated neurotoxicity syndrome (ICANS), cytopenias, and infections, between CAR T products that are commercially available for the treatment of NHL. RESULTS After a stringent study selection process, we used a cohort of 1364 patients enrolled in 15 prospective clinical trials investigating the use of axicabtagene ciloleucel (axi-cel), lisocabtagene maraleucel (liso-cel), and tisagenlecleucel (tisa-cel). We found that the rates of CRS and ICANS were significantly higher with axi-cel as compared to both liso-cel and tisa-cel. Conversely, we demonstrated that rates of all-grade and severe neutropenia were significantly greater with liso-cel. Febrile neutropenia and all-grade infection rates did not differ significantly between products though rates of severe infection were increased with axi-cel. CONCLUSIONS Overall, this study serves as the first to delineate toxicity profiles associated with various available CAR T products. By better understanding associated toxicities, it may become possible to tailor therapies towards individual patients and anticipate the development of toxicities at earlier stages.
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Affiliation(s)
- Samuel Yamshon
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY.
| | - Caitlin Gribbin
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Mohammad Alhomoud
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Nora Chokr
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Zhengming Chen
- Division of Biostatistics and Epidemiology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Michelle Demetres
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY
| | - Michelle Pasciolla
- Department of Pharmacy, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY
| | - John Leonard
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Tsiporah Shore
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Peter Martin
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
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22
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Leroy M, Deramoudt L, Pinturaud M, Demaret J, Alidjinou EK, Nudel M, Cavalieri D, Chahla WA, Odou P, Morschhauser F, Yakoub-Agha I, Simon N, Beauvais D. A second round of anti-CD19 CAR T-cell therapy in diffuse large B-cell lymphoma: when persistence pays off. Leuk Lymphoma 2024; 65:868-871. [PMID: 38440954 DOI: 10.1080/10428194.2024.2325188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/24/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Marie Leroy
- CHU Lille, Institut de Pharmacie, Lille, France
| | - Laure Deramoudt
- CHU Lille, Institut de Pharmacie, Lille, France
- Univ Lille, ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Marine Pinturaud
- CHU Lille, Institut de Pharmacie, Lille, France
- Univ Lille, ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Julie Demaret
- CHU Lille, Institut d'Immunologie, Lille, France
- CHU de Lille, Université de Lille, INSERM Infinite U1285, Lille, France
| | | | | | | | - Wadih Abou Chahla
- Department of Pediatric Hematology, Jeanne de Flandre Hospital, Lille University Hospital, Lille, France
| | - Pascal Odou
- CHU Lille, Institut de Pharmacie, Lille, France
- Univ Lille, ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Franck Morschhauser
- Univ Lille, ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
- Hematology Department, CHU Lille, Lille, France
| | - Ibrahim Yakoub-Agha
- CHU de Lille, Université de Lille, INSERM Infinite U1285, Lille, France
- Hematology Department, CHU Lille, Lille, France
| | - Nicolas Simon
- CHU Lille, Institut de Pharmacie, Lille, France
- Univ Lille, ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - David Beauvais
- Hematology Department, CHU Lille, Lille, France
- Univ Lille, Inserm U1192 - PRISM, Lille, France
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23
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Isaak AJ, Clements GR, Buenaventura RGM, Merlino G, Yu Y. Development of Personalized Strategies for Precisely Battling Malignant Melanoma. Int J Mol Sci 2024; 25:5023. [PMID: 38732242 PMCID: PMC11084485 DOI: 10.3390/ijms25095023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/27/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Melanoma is the most severe and fatal form of skin cancer, resulting from multiple gene mutations with high intra-tumor and inter-tumor molecular heterogeneity. Treatment options for patients whose disease has progressed beyond the ability for surgical resection rely on currently accepted standard therapies, notably immune checkpoint inhibitors and targeted therapies. Acquired resistance to these therapies and treatment-associated toxicity necessitate exploring novel strategies, especially those that can be personalized for specific patients and/or populations. Here, we review the current landscape and progress of standard therapies and explore what personalized oncology techniques may entail in the scope of melanoma. Our purpose is to provide an up-to-date summary of the tools at our disposal that work to circumvent the common barriers faced when battling melanoma.
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Affiliation(s)
| | | | | | | | - Yanlin Yu
- Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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24
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Li Y, Zheng Y, Liu T, Liao C, Shen G, He Z. The potential and promise for clinical application of adoptive T cell therapy in cancer. J Transl Med 2024; 22:413. [PMID: 38693513 PMCID: PMC11064426 DOI: 10.1186/s12967-024-05206-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/15/2024] [Indexed: 05/03/2024] Open
Abstract
Adoptive cell therapy has revolutionized cancer treatment, especially for hematologic malignancies. T cells are the most extensively utilized cells in adoptive cell therapy. Currently, tumor-infiltrating lymphocytes, T cell receptor-transgenic T cells and chimeric antigen receptor T cells are the three main adoptive T cell therapies. Tumor-infiltrating lymphocytes kill tumors by reinfusing enlarged lymphocytes that naturally target tumor-specific antigens into the patient. T cell receptor-transgenic T cells have the ability to specifically destroy tumor cells via the precise recognition of exogenous T cell receptors with major histocompatibility complex. Chimeric antigen receptor T cells transfer genes with specific antigen recognition structural domains and T cell activation signals into T cells, allowing T cells to attack tumors without the assistance of major histocompatibility complex. Many barriers have been demonstrated to affect the clinical efficacy of adoptive T cell therapy, such as tumor heterogeneity and antigen loss, hard trafficking and infiltration, immunosuppressive tumor microenvironment and T cell exhaustion. Several strategies to improve the efficacy of adoptive T cell therapy have been explored, including multispecific chimeric antigen receptor T cell therapy, combination with immune checkpoint blockade, targeting the immunosuppressive tumor microenvironment, etc. In this review, we will summarize the current status and clinical application, followed by major bottlenecks in adoptive T cell therapy. In addition, we will discuss the promising strategies to improve adoptive T cell therapy. Adoptive T cell therapy will result in even more incredible advancements in solid tumors if the aforementioned problems can be handled.
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Affiliation(s)
- Yinqi Li
- Department of Pharmacy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Yeteng Zheng
- Department of Pharmacy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Taiqing Liu
- Department of Pharmacy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Chuanyun Liao
- Department of Pharmacy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Guobo Shen
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China.
| | - Zhiyao He
- Department of Pharmacy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China.
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu, 610041, China.
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25
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Iacoboni G, Iraola‐Truchuelo J, O'Reilly M, Navarro V, Menne T, Kwon M, Martín‐López AÁ, Chaganti S, Delgado J, Roddie C, Pérez A, Norman J, Guerreiro M, Gibb A, Caballero AC, Besley C, Martínez‐Cibrián N, Mussetti A, Sanderson R, Luzardo H, Iyengar S, Sánchez JM, Jones C, Sancho J, Barba P, Latif A, López‐Corral L, Hernani R, Reguera JL, Sureda A, Garcia‐Sancho AM, Bastos M, Abrisqueta P, Kuhnl A. Treatment outcomes in patients with large B-cell lymphoma after progression to chimeric antigen receptor T-cell therapy. Hemasphere 2024; 8:e62. [PMID: 38774657 PMCID: PMC11106798 DOI: 10.1002/hem3.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/19/2024] [Accepted: 02/14/2024] [Indexed: 05/24/2024] Open
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.
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Affiliation(s)
- Gloria Iacoboni
- Department of HematologyUniversity Hospital Vall d'HebronBarcelonaSpain
- Experimental HematologyVall d'Hebron Institute of Oncology (VHIO)BarcelonaSpain
| | | | - Maeve O'Reilly
- Department of HematologyUniversity College London HospitalsLondonUK
| | - Víctor Navarro
- Oncology Data Science (ODySey) GroupVall d´Hebron Institute of Oncology (VHIO)BarcelonaSpain
| | - Tobias Menne
- Department of HematologyFreeman HospitalNewcastleUK
| | - Mi Kwon
- Department of HematologyHospital General Universitario Gregorio MarañónMadridSpain
| | - Ana África Martín‐López
- Hematology Department, Hospital Clínico Universitario de Salamanca, IBSAL, CIBERONCUniversity of SalamancaSalamancaSpain
| | | | - Javier Delgado
- Hematology Department, Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSICUniversidad de SevillaSevillaSpain
| | - Claire Roddie
- Department of HematologyUniversity College London HospitalsLondonUK
| | - Ariadna Pérez
- Haematology Department, Hospital Clínico UniversitarioINCLIVA Research InstituteValenciaSpain
| | - Jane Norman
- Department of HematologyManchester Royal InfirmaryManchesterUK
| | | | - Adam Gibb
- Department of HematologyThe Christie HospitalManchesterUK
| | | | - Caroline Besley
- Department of HematologyUniversity Hospitals Bristol and WestonBristolUK
| | | | - Alberto Mussetti
- Hematology Department, Institut Catala d'Oncologia, Hospital Duran i Reynals, L'Hospitalet De Llobregat, IDIBELLUniversitat de BarcelonaBarcelonaSpain
| | | | - Hugo Luzardo
- Department of HematologyHospital Universitario de Gran Canaria Doctor NegrínIslas CanariasSpain
| | - Sunil Iyengar
- Department of HematologyRoyal Marsden HospitalLondonUK
| | | | - Ceri Jones
- Department of HematologyUniversity Hospital of WalesCardiffUK
| | - Juan‐Manuel Sancho
- Hematology DepartmentICO‐IJC Hospital Germans Trias i PujolBarcelonaSpain
| | - Pere Barba
- Department of HematologyUniversity Hospital Vall d'HebronBarcelonaSpain
- Experimental HematologyVall d'Hebron Institute of Oncology (VHIO)BarcelonaSpain
| | | | - Lucia López‐Corral
- Hematology Department, Hospital Clínico Universitario de Salamanca, IBSAL, CIBERONCUniversity of SalamancaSalamancaSpain
| | - Rafael Hernani
- Haematology Department, Hospital Clínico UniversitarioINCLIVA Research InstituteValenciaSpain
| | - Juan Luis Reguera
- Hematology Department, Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSICUniversidad de SevillaSevillaSpain
| | - Anna Sureda
- Hematology Department, Institut Catala d'Oncologia, Hospital Duran i Reynals, L'Hospitalet De Llobregat, IDIBELLUniversitat de BarcelonaBarcelonaSpain
| | - Alejandro Martin Garcia‐Sancho
- Hematology Department, Hospital Clínico Universitario de Salamanca, IBSAL, CIBERONCUniversity of SalamancaSalamancaSpain
| | - Mariana Bastos
- Department of HematologyHospital General Universitario Gregorio MarañónMadridSpain
| | - Pau Abrisqueta
- Department of HematologyUniversity Hospital Vall d'HebronBarcelonaSpain
- Experimental HematologyVall d'Hebron Institute of Oncology (VHIO)BarcelonaSpain
| | - Andrea Kuhnl
- Department of HematologyKing's College HospitalLondonUK
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León-Román J, Iacoboni G, Bermejo S, Carpio C, Bolufer M, García-Carro C, Sánchez-Salinas M, Alonso-Martínez C, Bestard O, Barba P, Soler MJ. Transient acute kidney injury after chimeric antigen receptor T-cell therapy in patients with hematological malignancies. Clin Kidney J 2024; 17:sfae027. [PMID: 38500492 PMCID: PMC10946657 DOI: 10.1093/ckj/sfae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Indexed: 03/20/2024] Open
Abstract
Background Acute kidney injury (AKI) occurs in 30% of patients infused with chimeric antigen receptor (CAR) T-cells. The purpose of this study was to identify risk factors and long-term outcomes after AKI in patients who received CAR T-cell therapy. Methods Medical records of 115 adult patients with R/R hematological malignancies treated with CD19-targeted CAR T-cells at Vall d'Hebron University Hospital between July 2018 and May 2021. Baseline demographic data including age, gender, ethnicity, body mass index (BMI), and co-morbidities, as well as the type of hematological neoplasia and prior lines of therapy were collected. Laboratory parameters including serum creatinine and whole blood hemoglobin were retrospectively reviewed and values were gathered for days +1, +7, +14, +21, and +28 post-infusion. Results A total of 24/115 (21%) patients developed AKI related to CAR T-cell therapy; 6/24 with AKI over chronic kidney disease (CKD). Two patients had AKI in the context of lymphodepleting (LD) chemotherapy and the other 22 after CAR T-cell infusion, starting at day+1 in 3 patients, day+7 in 13 patients, day +14 in 1 patient, day+21 in 2 patients, and day+28 in 3 patients. Renal function was recovered in 19/24 (79%) patients within the first month after infusion. Male gender, CKD, cytokine release syndrome (CRS), and immune effector cell-associated neurotoxicity syndrome (ICANS) were associated with AKI. Male gender, CKD, ICANS grade ≥3 and CRS grade ≥2 were identified as independent risk factors for AKI on multivariable analysis. In terms of the most frequent CAR T-cell related complications, CRS was observed in 95 (82%) patients and ICANS in 33 (29%) patients. Steroids were required in 34 (30%) patients and tocilizumab in 37 (32%) patients. Six (5%) patients were admitted to the intensive care unit (1 for septic shock, 4 for CRS grade ≥2 associated to ICANS grade ≥2, and 1 for CRS grade ≥3). A total of 5 (4.4%) patients died in the first 30 days after CAR T-cell infusion for reasons other than disease progression, including 4 cases of infectious complications and 1 of heart failure. Conclusion Our results suggest that AKI is a frequent but mild adverse event, with fast recovery in most patients.
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Affiliation(s)
- Juan León-Román
- Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research, CSUR National Unit of Expertise for Complex Glomerular Diseases of Spain, Barcelona, Spain
| | - Gloria Iacoboni
- Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Sheila Bermejo
- Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research, CSUR National Unit of Expertise for Complex Glomerular Diseases of Spain, Barcelona, Spain
| | - Cecilia Carpio
- Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Mónica Bolufer
- Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research, CSUR National Unit of Expertise for Complex Glomerular Diseases of Spain, Barcelona, Spain
| | - Clara García-Carro
- Nephrology Department, San Carlos Clinical University Hospital, Madrid, Spain
| | - Mario Sánchez-Salinas
- Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Carla Alonso-Martínez
- Pharmacy Department, Vall d´Hebron Hospital Universitari, Vall d´Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Oriol Bestard
- Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research, CSUR National Unit of Expertise for Complex Glomerular Diseases of Spain, Barcelona, Spain
| | - Pere Barba
- Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - María José Soler
- Nephrology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research, CSUR National Unit of Expertise for Complex Glomerular Diseases of Spain, Barcelona, Spain
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27
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de la Iglesia-San Sebastián I, Carbonell D, Bastos-Oreiro M, Pérez-Corral A, Bailén R, Chicano M, Muñiz P, Monsalvo S, Escudero-Fernández A, Oarbeascoa G, Fernández-Caldas P, Gómez-Centurión I, Pion M, Gayoso J, Anguita J, Kwon M, Díez-Martín JL, Buño I, Martínez-Laperche C. Digital PCR Improves Sensitivity and Quantification in Monitoring CAR-T Cells in B Cell Lymphoma Patients. Transplant Cell Ther 2024; 30:306.e1-306.e12. [PMID: 38184148 DOI: 10.1016/j.jtct.2023.12.672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 01/08/2024]
Abstract
Chimeric antigen receptor T cells (CAR-T) has emerged as a promising therapy, over 60% of patients fail to sustain a long-term response. The underlying factors that leads to the effectiveness of this therapy are not completely understood, CAR-T cell persistence and monitoring seems to be pivotal for ensuring a successful response. Various monitoring methods such as multiparametric flow cytometry (MFC) or quantitative PCR (qPCR) have been applied. Our objective is to develop digital PCR (dPCR) assays for detection and quantification of CAR-T cells, comparing them with MFC and qPCR. Samples taken at different follow-up times from 45 patients treated with CAR-T therapy were analyzed to assess the correlation between the different methodologies. dPCR presented a high correlation with MFC and qPCR (r = 0.97 and r = 0.87, respectively), while offering a higher sensitivity (0.01%) compared to MFC (0.1%) and qPCR (1%). dPCR emerged as an alternative and highly sensitivity method for monitoring CAR-T cell dynamics. This technique is well-suited for implementation in clinical practice as a complementary technique to MFC.
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Affiliation(s)
- Ismael de la Iglesia-San Sebastián
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Diego Carbonell
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Mariana Bastos-Oreiro
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ana Pérez-Corral
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Rebeca Bailén
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Maria Chicano
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Paula Muñiz
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Silvia Monsalvo
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | - Gillen Oarbeascoa
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Paula Fernández-Caldas
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ignacio Gómez-Centurión
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Marjorie Pion
- Advanced Immuno Regulation Group, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jorge Gayoso
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Javier Anguita
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Mi Kwon
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - José Luis Díez-Martín
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Department of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Ismael Buño
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Department of Cell Biology, Complutense University of Madrid, Madrid, Spain; Genomics Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Carolina Martínez-Laperche
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
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Belbachir S, Purtill D. Bridging therapy before axi-cel for lymphoma. Blood Adv 2024; 8:1051-1052. [PMID: 38411993 PMCID: PMC10920097 DOI: 10.1182/bloodadvances.2023012128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Affiliation(s)
- Safia Belbachir
- Haematology Service, Fiona Stanley Hospital, Perth, WA, Australia
| | - Duncan Purtill
- Haematology Service, Fiona Stanley Hospital, Perth, WA, Australia
- Haematology Department, PathWest Laboratory Medicine, Perth, WA, Australia
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29
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Ghilardi G, Paruzzo L, Svoboda J, Chong EA, Shestov AA, Chen L, Cohen IJ, Gabrielli G, Nasta SD, Porazzi P, Landsburg DJ, Gerson JN, Carter J, Barta SK, Yelton R, Pajarillo R, Patel V, White G, Ballard HJ, Weber E, Napier E, Chong ER, Fraietta JA, Garfall AL, Porter DL, Milone MC, O’Connor R, Schuster SJ, Ruella M. Bendamustine lymphodepletion before axicabtagene ciloleucel is safe and associates with reduced inflammatory cytokines. Blood Adv 2024; 8:653-666. [PMID: 38113468 PMCID: PMC10839610 DOI: 10.1182/bloodadvances.2023011492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/27/2023] [Accepted: 11/27/2023] [Indexed: 12/21/2023] Open
Abstract
ABSTRACT Lymphodepletion (LD) is an integral component of chimeric antigen receptor T-cell (CART) immunotherapies. In this study, we compared the safety and efficacy of bendamustine (Benda) to standard fludarabine/cyclophosphamide (Flu/Cy) LD before CD19-directed, CD28-costimulated CART axicabtagene ciloleucel (axi-cel) for patients with large B-cell lymphoma (LBCL) and follicular lymphoma (FL). We analyzed 59 patients diagnosed with LBCL (n = 48) and FL (n = 11) consecutively treated with axi-cel at the University of Pennsylvania. We also analyzed serum samples for cytokine levels and metabolomic changes before and after LD. Flu/Cy and Benda demonstrated similar efficacy, with complete remission rates of 51.4% and 50.0% (P = .981), respectively, and similar progression-free and overall survivals. Any-grade cytokine-release syndrome occurred in 91.9% of patients receiving Flu/Cy vs 72.7% of patients receiving Benda (P = .048); any-grade neurotoxicity after Flu/Cy occurred in 45.9% of patients and after Benda in 18.2% of patients (P = .031). In addition, Flu/Cy was associated with a higher incidence of grade ≥3 neutropenia (100% vs 54.5%; P < .001), infections (78.4% vs 27.3%; P < .001), and neutropenic fever (78.4% vs 13.6%; P < .001). These results were confirmed both in patients with LBCL and those with FL. Mechanistically, patients with Flu/Cy had a greater increase in inflammatory cytokines associated with neurotoxicity and reduced levels of metabolites critical for redox balance and biosynthesis. This study suggests that Benda LD may be a safe alternative to Flu/Cy for CD28-based CART CD19-directed immunotherapy with similar efficacy and reduced toxicities. Benda is associated with reduced levels of inflammatory cytokines and increased anabolic metabolites.
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Affiliation(s)
- Guido Ghilardi
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Luca Paruzzo
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
- Department of Oncology, University of Turin, Turin, Italy
| | - Jakub Svoboda
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Eise A. Chong
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Alexander A. Shestov
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Linhui Chen
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Ivan J. Cohen
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Giulia Gabrielli
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Sunita D. Nasta
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Patrizia Porazzi
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Daniel J. Landsburg
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - James N. Gerson
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jordan Carter
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Stefan K. Barta
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Rebecca Yelton
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Raymone Pajarillo
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Vrutti Patel
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Griffin White
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Hatcher J. Ballard
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Elizabeth Weber
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Ellen Napier
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Emeline R. Chong
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Joseph A. Fraietta
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
| | - Alfred L. Garfall
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - David L. Porter
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Michael C. Milone
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Roderick O’Connor
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stephen J. Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Marco Ruella
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
- Center for Cellular Immunotherapies, University of Pennsylvania, Philadelphia, PA
- Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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30
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Boyle S, Roddie C, O'Reilly M, Menne T, Norman J, Gibb A, Lugthart S, Chaganti S, Gonzalez Arias C, Jones C, Latif A, Uttenthal BJ, Seymour F, Osborne W, Springell D, Hardefeldt P, Yallop D, Thoulouli E, Bloor A, Besley C, Mathew A, Burns D, Cwynarski K, Sanderson R, Kuhnl A. Improved outcomes of large B-cell lymphoma patients treated with CD19 CAR T in the UK over time. Br J Haematol 2024; 204:507-513. [PMID: 37848384 DOI: 10.1111/bjh.19157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023]
Abstract
The success of CD19 Chimeric antigen receptor (CAR) T-cell therapy in large B-cell lymphoma (LBCL) has been partially offset by toxicity and logistical challenges, which off-the-shelf agents like CD20xCD3 bispecific antibodies might potentially overcome. However, when using CAR T outcomes as the 'standard-of-care comparator̕ for relapsed/refractory (r/r) LBCL, a potential learning curve with implementing a novel, complex therapy like CAR T needs to be considered. To address this, we analysed 726 UK patients intended to be treated with CD19 CAR T for r/r LBCL and compared outcomes between the first year of the national CAR T programme (Era 1; 2019) and the more recent treatment era (Era 2; 2020-2022). We identified significant improvements for Era 2 versus Era 1 in dropout rate (17% vs. 27%, p = 0.001), progression-free survival (1-year PFS 50% vs. 32%, p < 0.001) and overall survival (1-year OS 60% vs. 40%, p < 0.001). We also observed increased use of bridging therapy, improvement in bridging outcomes, more tocilizumab/corticosteroid use, reduced high-grade cytokine release syndrome (4% vs. 9%, p = 0.01) and intensive care unit admissions (20% vs. 32%, p = 0.001). Our results demonstrate significant improvement in CAR T outcomes over time, highlighting the importance of using up-to-date clinical data when comparing CAR T against new treatment options for r/r LBCL.
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Affiliation(s)
- S Boyle
- Department of Haematology, King's College Hospital, London, UK
| | - C Roddie
- Department of Haematology, University College London Hospitals, London, UK
| | - M O'Reilly
- Department of Haematology, University College London Hospitals, London, UK
- Department of Haematology, UCL Cancer Institute, University College London, London, UK
| | - T Menne
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - J Norman
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - A Gibb
- Department of Medical Oncology, The Christie Hospital, Manchester, UK
| | - S Lugthart
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | - S Chaganti
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | | | - C Jones
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - A Latif
- Department of Haematology, Queen Elizabeth II Hospital, Glasgow, UK
| | - B J Uttenthal
- Department of Haematology, Cambridge University Hospitals, Cambridge, UK
| | - F Seymour
- Department of Haematology, Leeds Teaching Hospitals, Leeds, UK
| | - W Osborne
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - D Springell
- Department of Haematology, University College London Hospitals, London, UK
| | - P Hardefeldt
- Department of Haematology, King's College Hospital, London, UK
| | - D Yallop
- Department of Haematology, King's College Hospital, London, UK
| | - E Thoulouli
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - A Bloor
- Department of Haematology, The Christie Hospital, Manchester, UK
| | - C Besley
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | - A Mathew
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - D Burns
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - K Cwynarski
- Department of Haematology, University College London Hospitals, London, UK
| | - R Sanderson
- Department of Haematology, King's College Hospital, London, UK
| | - A Kuhnl
- Department of Haematology, King's College Hospital, London, UK
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31
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Iacoboni G, Navarro V, Martín-López AÁ, Rejeski K, Kwon M, Jalowiec KA, Amat P, Reguera-Ortega JL, Gallur L, Blumenberg V, Gutiérrez-Herrero S, Roddie C, Benzaquén A, Delgado-Serrano J, Sánchez-Salinas MA, Bailén R, Carpio C, López-Corral L, Hernani R, Bastos M, O'Reilly M, Martín-Martín L, Subklewe M, Barba P. Recent Bendamustine Treatment Before Apheresis Has a Negative Impact on Outcomes in Patients With Large B-Cell Lymphoma Receiving Chimeric Antigen Receptor T-Cell Therapy. J Clin Oncol 2024; 42:205-217. [PMID: 37874957 DOI: 10.1200/jco.23.01097] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/10/2023] [Accepted: 08/21/2023] [Indexed: 10/26/2023] Open
Abstract
PURPOSE Approximately 30%-40% of patients with relapsed/refractory (R/R) large B-cell lymphoma (LBCL) infused with CD19-targeted chimeric antigen receptor (CAR) T cells achieve durable responses. Consensus guidelines suggest avoiding bendamustine before apheresis, but specific data in this setting are lacking. We report distinct outcomes after CAR T-cell therapy according to previous bendamustine exposure. METHODS The study included CAR T-cell recipients from seven European sites. Safety, efficacy, and CAR T-cell expansion kinetics were analyzed according to preapheresis bendamustine exposure. Additional studies on the impact of the washout period and bendamustine dose were performed. Inverse probability treatment weighting (IPTW) and propensity score matching (PSM) analyses were carried out for all efficacy comparisons between bendamustine-exposed and bendamustine-naïve patients. RESULTS The study included 439 patients with R/R LBCL infused with CD19-targeted commercial CAR T cells, of whom 80 had received bendamustine before apheresis. Exposed patients had significantly lower CD3+ cells and platelets at apheresis. These patients had a lower overall response rate (ORR, 53% v 72%; P < .01), a shorter progression-free survival (PFS, 3.1 v 6.2 months; P = .04), and overall survival (OS, 10.3 v 23.5 months; P = .01) in comparison with the bendamustine-naïve group. Following adjustment methods for baseline variables, these differences were mitigated. Focusing on the impact of bendamustine washout before apheresis, those with recent (<9 months) exposure (N = 42) displayed a lower ORR (40% v 72%; P < .01), shorter PFS (1.3 v 6.2 months; P < .01), and OS (4.6 v 23.5 months; P < .01) in comparison with bendamustine-naïve patients. These differences remained significant after IPTW and PSM analysis. Conversely, the cumulative dose of bendamustine before apheresis did not affect CAR-T efficacy outcomes. CONCLUSION Recent bendamustine exposure before apheresis was associated with negative treatment outcomes after CD19-targeted CAR T-cell therapy and should be therefore avoided in CAR T-cell candidates.
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Affiliation(s)
- Gloria Iacoboni
- Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain
- Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Víctor Navarro
- Oncology Data Science (ODySey) Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Ana África Martín-López
- Hematology Department, Hospital Clínico Universitario de Salamanca, IBSAL, CIBERONC, Salamanca, Spain
- Centro de Investigación del Cáncer-IBMCC, Salamanca, Spain
| | - Kai Rejeski
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Laboratory for Translational Cancer Immunology, Gene Center of the LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK) and Bavarian Center for Cancer Research (BZKF), partner site Munich, Munich, Germany
| | - Mi Kwon
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - Katarzyna Aleksandra Jalowiec
- Hematology Department, University College London Cancer Institute, London, United Kingdom
- Department of Hematology and Central Hematology Laboratory, University Hospital of Bern, Bern, Switzerland
| | - Paula Amat
- Haematology Department, Hospital Clínico Universitario, Valencia, Spain
- INCLIVA Research Institute, Valencia, Spain
| | - Juan Luis Reguera-Ortega
- Hematology Department, Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Laura Gallur
- Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain
- Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Viktoria Blumenberg
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Laboratory for Translational Cancer Immunology, Gene Center of the LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK) and Bavarian Center for Cancer Research (BZKF), partner site Munich, Munich, Germany
| | - Sara Gutiérrez-Herrero
- Cancer Research Centre (IBMCC, USAL-CSIC), Institute for Biomedical Research of Salamanca (IBSAL) and Department of Medicine and Cytometry Service (NUCLEUS Research Support Platform), University of Salamanca (USAL), Salamanca, Spain
| | - Claire Roddie
- Hematology Department, University College London Cancer Institute, London, United Kingdom
| | - Ana Benzaquén
- Haematology Department, Hospital Clínico Universitario, Valencia, Spain
- INCLIVA Research Institute, Valencia, Spain
| | - Javier Delgado-Serrano
- Hematology Department, Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Mario Andrés Sánchez-Salinas
- Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain
- Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Rebeca Bailén
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - Cecilia Carpio
- Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain
- Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Lucia López-Corral
- Hematology Department, Hospital Clínico Universitario de Salamanca, IBSAL, CIBERONC, Salamanca, Spain
- Centro de Investigación del Cáncer-IBMCC, Salamanca, Spain
| | - Rafael Hernani
- Haematology Department, Hospital Clínico Universitario, Valencia, Spain
- INCLIVA Research Institute, Valencia, Spain
| | - Mariana Bastos
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - Maeve O'Reilly
- Hematology Department, University College London Cancer Institute, London, United Kingdom
| | - Lourdes Martín-Martín
- Cancer Research Centre (IBMCC, USAL-CSIC), Institute for Biomedical Research of Salamanca (IBSAL) and Department of Medicine and Cytometry Service (NUCLEUS Research Support Platform), University of Salamanca (USAL), Salamanca, Spain
| | - Marion Subklewe
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Laboratory for Translational Cancer Immunology, Gene Center of the LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK) and Bavarian Center for Cancer Research (BZKF), partner site Munich, Munich, Germany
| | - Pere Barba
- Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain
- Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
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32
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Kalim M, Jing R, Li X, Jiang Z, Zheng N, Wang Z, Wei G, Lu Y. Essentials of CAR-T Therapy and Associated Microbial Challenges in Long Run Immunotherapy. JOURNAL OF CELLULAR IMMUNOLOGY 2024; 6:22-50. [PMID: 38883270 PMCID: PMC11172397 DOI: 10.33696/immunology.6.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Chimeric antigen receptor (CAR)-T cell therapy has shown potential in improving outcomes for individuals with hematological malignancies. However, achieving long-term full remission for blood cancer remains challenging due to severe life-threatening toxicities such as limited anti-tumor efficacy, antigen escape, trafficking restrictions, and limited tumor invasion. Furthermore, the interactions between CAR-T cells and their host tumor microenvironments have a significant impact on CAR-T function. To overcome these considerable hurdles, fresh methodologies and approaches are needed to produce more powerful CAR-T cells with greater anti-tumor activity and less toxicity. Despite advances in CAR-T research, microbial resistance remains a significant obstacle. In this review, we discuss and describe the basics of CAR-T structures, generations, challenges, and potential risks of infections in CAR-T cell therapy.
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Affiliation(s)
- Muhammad Kalim
- Houston Methodist Cancer Center/Weill Cornell Medicine, Houston, TX 77030, USA
| | - Rui Jing
- Houston Methodist Cancer Center/Weill Cornell Medicine, Houston, TX 77030, USA
| | - Xin Li
- Houston Methodist Cancer Center/Weill Cornell Medicine, Houston, TX 77030, USA
| | - Zhiwu Jiang
- Houston Methodist Cancer Center/Weill Cornell Medicine, Houston, TX 77030, USA
| | - Ningbo Zheng
- Department of Microbiology & Immunology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Ziyu Wang
- Houston Methodist Cancer Center/Weill Cornell Medicine, Houston, TX 77030, USA
| | - Guo Wei
- Houston Methodist Cancer Center/Weill Cornell Medicine, Houston, TX 77030, USA
| | - Yong Lu
- Houston Methodist Cancer Center/Weill Cornell Medicine, Houston, TX 77030, USA
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33
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Benzaquén A, Giménez E, Iacoboni G, Guerreiro M, Hernani R, Albert E, Carpio C, Balaguer A, Pérez A, S de la Asunción C, Sánchez-Salinas MA, Chorão P, Piñana JL, Beas F, Montoro J, Hernández-Boluda JC, Facal A, Ferrer B, Villalba M, Amat P, Goméz MD, Campos D, Terol MJ, Sanz J, Barba P, Navarro D, Solano C. Torque Teno Virus plasma DNA load: a novel prognostic biomarker in CAR-T therapy. Bone Marrow Transplant 2024; 59:93-100. [PMID: 37919456 DOI: 10.1038/s41409-023-02114-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/31/2023] [Accepted: 09/20/2023] [Indexed: 11/04/2023]
Abstract
Torque Teno Virus (TTV) is a single-stranded circular DNA virus which has been identified as a surrogate marker of immune competence in transplantation. In this study we investigated the dynamics of plasma TTV DNAemia in 79 adult patients undergoing chimeric antigen receptor T-cell (CAR-T) therapy for relapsed or refractory large B-cell lymphoma, also evaluating the impact of TTV on immunotoxicities, response and survival outcomes. After lymphodepleting therapy, TTV DNA load was found to decrease slightly until reaching nadir around day 10, after which it increased steadily until reaching maximum load around day 90. TTV DNA load < 4.05 log10 copies/ml at immune effector cell-associated neurotoxicity syndrome (ICANS) onset identified patients at risk of progressing to severe forms of ICANS (OR 16.68, P = 0.048). Finally, patients who experienced falling or stable TTV DNA load between lymphodepletion and CAR-T infusion had better progression-free survival than those with ascending TTV DNA load (HR 0.31, P = 0.006). These findings suggest that TTV monitoring could serve as a surrogate marker of immune competence, enabling predictions of CAR-T efficacy and toxicity. This could pave the way for the development of TTV-guided therapeutic strategies that modulate clinical patient management based on plasma TTV load, similar to suggested strategies in solid organ transplant recipients.
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Affiliation(s)
- Ana Benzaquén
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Estela Giménez
- Microbiology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Gloria Iacoboni
- Haematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Manuel Guerreiro
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Rafael Hernani
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Eliseo Albert
- Microbiology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Cecilia Carpio
- Haematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Aitana Balaguer
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ariadna Pérez
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Carlos S de la Asunción
- Microbiology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | | | - Pedro Chorão
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - José Luis Piñana
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Francisco Beas
- Haematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Juan Montoro
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Juan Carlos Hernández-Boluda
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Ana Facal
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Blanca Ferrer
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - Marta Villalba
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Paula Amat
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - María Dolores Goméz
- Microbiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Diana Campos
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | - María José Terol
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Jaime Sanz
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Pere Barba
- Haematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | - David Navarro
- Microbiology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
- Department of Microbiology, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Solano
- Haematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
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Yagi Y, Kanemasa Y, Sasaki Y, Goto S, Yamamura Y, Masuda Y, Fujita K, Ishimine K, Hayashi Y, Mino M, Ohigashi A, Morita Y, Tamura T, Nakamura S, Okuya T, Matsuda S, Shimizuguchi T, Shingai N, Toya T, Shimizu H, Najima Y, Kobayashi T, Haraguchi K, Doki N, Okuyama Y, Shimoyama T. Early failure is still a poor prognostic factor in patients with relapsed or refractory large B-cell lymphoma in the era of CAR T-cell therapy. J Clin Exp Hematop 2024; 64:107-118. [PMID: 38925972 PMCID: PMC11303961 DOI: 10.3960/jslrt.24009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 06/28/2024] Open
Abstract
Patients with refractory or relapsed (R/R) large B-cell lymphoma (LBCL) refractory to first-line chemotherapy or with early relapse have poor outcomes. While chimeric antigen receptor (CAR) T-cell therapy has impressive efficacy after two or more lines of chemotherapy, it's still uncertain if these outcomes remain consistent in the context of third-line CAR T-cell therapy. We conducted a retrospective study of 107 R/R LBCL patients. Patients with relapse 12 months or more after their first-line chemoimmunotherapy (late failure: n = 25) had significantly longer overall survival (OS) than patients with refractory disease or relapse within 12 months (early failure: n = 82) (median OS: not achieved vs. 18.4 months; P < 0.001). Among patients who proceeded to autologous hematopoietic stem-cell transplantation (auto-HSCT), those with late failure had significantly longer event-free survival (EFS) than those with early failure (median EFS: 26.9 vs. 3.1 months; P = 0.012). However, no significant difference in EFS was detected among patients who underwent CAR T-cell therapy (median EFS: not reached vs. 11.8; P = 0.091). Cox regression with restricted cubic spline demonstrated that timing of relapse had significant impact on EFS in patients with auto-HSCT but not in patients with CAR T-cell therapy. Of patients who were scheduled for CAR T-cell therapy, those with late failure were significantly more likely to receive CAR T-cell therapy than those with early failure (90% vs. 57%; P = 0.008). In conclusion, patients with early failure still experienced poor outcomes after the approval of third-line CAR T-cell therapy.
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García-Sancho AM, Cabero A, Gutiérrez NC. Treatment of Relapsed or Refractory Diffuse Large B-Cell Lymphoma: New Approved Options. J Clin Med 2023; 13:70. [PMID: 38202077 PMCID: PMC10779497 DOI: 10.3390/jcm13010070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/03/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024] Open
Abstract
Overall, around 40% of patients with diffuse large B-cell lymphoma (DLBCL) have refractory disease or relapse after the first line of treatment. Until relatively recently, the prognosis of patients with relapsed or refractory DLBCL was very poor and treatment options were very limited. In recent years, several novel therapies have been approved that provide more effective options than conventional chemotherapy and that have manageable toxicity profiles. CAR-T cell therapy has become the new standard treatment for patients with refractory or early relapsed DLBCL, based on the positive results of the phase 3 ZUMA-7 and TRANSFORM clinical trials. This review addresses the role of CAR-T therapy and autologous stem cell transplantation in the treatment of these patients and other approved options for patients who are not candidates for transplant, such as the combinations of polatuzumab vedotin with bendamustine and rituximab, and tafasitamab with lenalidomide.
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Affiliation(s)
- Alejandro Martín García-Sancho
- Hematology Department, University Hospital of Salamanca, IBSAL (Instituto de Investigación Biomédica de Salamanca), CIBERONC (Centro de Investigación Biomédica en Red en Cáncer ), University of Salamanca, 37007 Salamanca, Spain; (A.C.); (N.C.G.)
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36
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Mussetti A, Fabbri N, Sureda A. CAR T-cell therapy in aggressive lymphomas-identifying prognostic and predictive markers. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:357-363. [PMID: 38066912 PMCID: PMC10727003 DOI: 10.1182/hematology.2023000436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
We discuss different pre-infusion, post-infusion and post-CAR T-cell relapse prognostic factors influencing the outcomes of anti-CD19 CAR T-cell therapy in patients with relapsed or refractory large B-cell lymphomas. Despite the overall positive results of anti-CD19 CAR T-cell therapy, a significant percentage of patients relapse. We summarize the efforts made to identify predictive factors for response and durable remissions and survival. In the pre-infusion setting, the patient-related factors discussed include Eastern Cooperative Oncology Group performance status, age, and comorbidities. Disease-related factors like tumor burden, histology, and biological features are also considered. In addition, inflammation-related factors and CAR T-cell product-related factors are considered. After CAR T-cell infusion, factors such as disease response assessed by 18FDG-PET/CT scan, liquid biopsy monitoring, and CAR T-cell expansion become crucial in predicting survival outcomes. Response to 18FDG-PET/CT scan is a widely used test for confirming response and predicting survival. Liquid biopsy, in combination with 18FDG-PET/CT scan, has shown potential in predicting outcomes. CAR T-cell expansion and persistence have shown mixed effects on survival, with some studies indicating their association with response. In the setting of post-CAR T-cell relapse, prognostic factors include refractory disease, time of relapse, and elevated lactate dehydrogenase levels at CAR T-cell infusion. Enrollment in clinical trials is crucial for improving outcomes in these patients. Overall, we discuss a comprehensive overview of prognostic factors that can influence the outcomes of anti-CD19 CAR T-cell therapy in patients with relapsed or refractory large B-cell lymphomas, highlighting the need for personalized approaches in treatment decision-making.
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Affiliation(s)
- Alberto Mussetti
- Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nicole Fabbri
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Anna Sureda
- Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Medicine Department, Universitat de Barcelona, Barcelona, Spain
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Dreger P, Corradini P, Gribben JG, Glass B, Jerkeman M, Kersten MJ, Morschhauser F, Mussetti A, Viardot A, Zinzani PL, Sureda A. CD19-directed CAR T cells as first salvage therapy for large B-cell lymphoma: towards a rational approach. Lancet Haematol 2023; 10:e1006-e1015. [PMID: 38030311 DOI: 10.1016/s2352-3026(23)00307-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/09/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023]
Abstract
The approval of CD19-directed chimeric antigen receptor (CAR) T-cell therapies for the second-line treatment of high-risk large B-cell lymphoma (LBCL) has greatly affected salvage algorithms for this condition, and such therapies could have the potential to improve the course of relapsed or refractory LBCL. In this Review, we provide guidance for a rational management approach to the use of commercial CD19-directed CAR T cells in the second-line treatment of LBCL, addressing crucial questions regarding eligible histologies; age, comorbidity, and tumour biology restrictions; the handling of very aggressive tumour behaviour; and holding and bridging therapies. The guidance was developed in a structured manner and, for each question, consists of a description of the clinical issue, a summary of the evidence, the rationale for a practical management approach, and recommendations. These recommendations could help to decide on the optimal management of patients with relapsed or refractory LBCL who are considered for second-line CAR T-cell treatment.
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Affiliation(s)
- Peter Dreger
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany.
| | - Paolo Corradini
- Division of Hematology, IRCCS Istituto Nazionale dei Tumori Milano, University of Milano, Milan, Italy
| | - John G Gribben
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Bertram Glass
- Department of Hematology and Cell Therapy, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Mats Jerkeman
- Department of Oncology, Skane University Hospital, Lund, Sweden
| | - Marie Jose Kersten
- Department of Hematology, Amsterdam UMC, location AMC, Cancer Center Amsterdam and LYMMCARE, Amsterdam, Netherlands
| | - Franck Morschhauser
- Hematology Department, CHU Lille, Université de Lille, ULR 7365, Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | - Alberto Mussetti
- Hematology Department, Institut Català d'Oncologia - Hospitalet, Institut d'Investigació Biomèdique de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Andreas Viardot
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy; Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Anna Sureda
- Hematology Department, Institut Català d'Oncologia - Hospitalet, Institut d'Investigació Biomèdique de Bellvitge, Universitat de Barcelona, Barcelona, Spain
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38
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Derigs P, Bethge WA, Krämer I, Holtick U, von Tresckow B, Ayuk F, Penack O, Vucinic V, von Bonin M, Baldus C, Mougiakakos D, Wulf G, Schnetzke U, Stelljes M, Fante M, Schroers R, Kroeger N, Dreger P. Long-Term Survivors after Failure of Chimeric Antigen Receptor T Cell Therapy for Large B Cell Lymphoma: A Role for Allogeneic Hematopoietic Cell Transplantation? A German Lymphoma Alliance and German Registry for Stem Cell Transplantation Analysis. Transplant Cell Ther 2023; 29:750-756. [PMID: 37709204 DOI: 10.1016/j.jtct.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/17/2023] [Accepted: 09/11/2023] [Indexed: 09/16/2023]
Abstract
The outcome of patients with large B cell lymphoma (LBCL) who relapse or progress after CD19-directed chimeric antigen receptor T cell therapy (CAR-T) administered as salvage therapy beyond the second treatment line is poor. However, a minority of patients become long-term survivors despite CAR-T failure. The German Lymphoma Alliance (GLA) has proposed a hierarchical management algorithm for CAR-T failure in LBCL, aimed at allogeneic hematopoietic cell transplantation (alloHCT) as definite therapy in eligible patients. The purpose of this study was to investigate characteristics, relapse patterns, and management strategies in long-term survivors after CAR-T failure, with a particular focus on the feasibility and outcome of alloHCT. This was a retrospective analysis of all evaluable patients with a relapse/progression event (REL) observed in a previously reported GLA sample between November 2018 and May 2021. REL occurred in 214 of 356 patients (60%) who underwent CAR-T for LBCL in the previous GLA study. An evaluable dataset was available for 143 of these 214 patients (67%). Twenty-six of 143 patients (18%) survived 12 months or longer from REL, 109 (76%) died within the first year after REL, and 8 (6%) were alive but had not reached the 12-month landmark. Long-term survivors had more favorable pre-CAR-T features, had a longer interval between CAR-T and REL, and had more often received a tumor biopsy after CAR-T failure, whereas the choice of the first salvage regimen had no impact. AlloHCT was feasible in 40 of 53 patients (75%) intended and resulted in a 12-month post-transplantation overall survival of 36% in those patients who underwent transplantation with sensitive or untreated REL. AlloHCT after CAR-T failure in LBCL is feasible and may be an important contributor to long-term survival, although selection bias must be taken into account. Thus, alloHCT should be considered as a reasonable treatment option for eligible patients in this setting. However, because the overall outlook after CAR-T failure remains poor, novel effective therapeutic approaches are needed, either to allow long-term disease control per se or to improve the preconditions for successful alloHCT.
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Affiliation(s)
- Patrick Derigs
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany.
| | - Wolfgang A Bethge
- Department of Internal Medicine II, University Hospital Tuebingen, Tuebingen, Germany
| | - Isabelle Krämer
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Udo Holtick
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Bastian von Tresckow
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center and German Cancer Consortium (DKTK partner site Essen), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf Penack
- Department of Hematology, Oncology and Tumorimmunology, University Hospital Charité Berlin, Berlin, Germany
| | - Vladan Vucinic
- Medical Department for Hematology, Cell Therapy and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - Malte von Bonin
- Department of Internal Medicine I, University Hospital Dresden, Dresden, Germany
| | - Claudia Baldus
- Department of Internal Medicine II, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Gerald Wulf
- Department of Hematology and Medical Oncology, University Medicine Goettingen, Goettingen, Germany
| | - Ulf Schnetzke
- Department of Internal Medicine II, University Hospital Jena, Jena, Germany
| | - Matthias Stelljes
- Department of Medicine A, University Hospital Muenster, Muenster, Germany
| | - Matthias Fante
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Roland Schroers
- Department of Hematology and Oncology, Ruhr-University Bochum, Bochum, Germany
| | - Nicolaus Kroeger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Dreger
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
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39
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Bastos-Oreiro M, Gutierrez A, Iacoboni G, López Corral L, Reguera JL, Abrisqueta P, Delgado J, Terol MJ, Hernani R, Martínez N, Ortíz V, Bailen R, Gomez-Centurión I, Caballero A, Sanz J, Guerra Domínguez L, Luzardo H, Mussetti A, Jiménez-Ubieto A, Sancho JM, Sureda A, Pérez A, Barba P, Kwon M, Martín García-Sancho A. Impact of SCHOLAR-1 Criteria on Chimeric Antigen Receptor T Cell Therapy Efficacy in Aggressive B Lymphoma: A Real-World GELTAMO/GETH Study. Transplant Cell Ther 2023; 29:747.e1-747.e10. [PMID: 37659694 DOI: 10.1016/j.jtct.2023.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/17/2023] [Accepted: 08/27/2023] [Indexed: 09/04/2023]
Abstract
In the pre-chimeric antigen receptor T cell (CAR-T) therapy era, the SCHOLAR-1 study identified a group of patients with refractory aggressive B cell lymphoma (ABCL) with particularly poor prognoses. We recently published our real-world data from Spain, focused on this SCHOLAR-1 refractory group, and compared patients who underwent CAR-T therapy with the previous standard of care. In this study, we found that the efficacy of CAR-T therapy in refractory patients, in terms of progression-free survival (PFS) and overall survival (OS), was superior to that of the treatments available in the pre-CAR-T era. The main objective of these new analyses was to analyze treatment efficacy in terms of response rates and survival for patients with ABCL with or without the SCHOLAR-1 criteria. In addition, we analyzed the prognostic impact of each SCHOLAR-1 criterion independently. Our study aimed to assess the prognostic impact of SCHOLAR-1 criteria on ABCL patients treated with CAR-T therapy in Spain. This multicenter, retrospective, observational study. We included all adult patients treated with commercially available CAR-T cell products and diagnosed with ABCL different from primary mediastinal large B cell lymphoma between February 2019 and July 2022. Patients meeting any SCHOLAR-1 criteria (progressive disease as the best response to any line of therapy, stable disease as the best response to ≥4 cycles of first-line therapy or ≥2 cycles of later-line therapy, or relapse at <12 months after autologous stem cell transplantation [auto-SCT]) in the line of treatment before CAR-T therapy (SCHOLAR-1 group) were compared with those not meeting any of these criteria (non-SCHOLAR-1 group). To analyze the prognostic impact of individual SCHOLAR-1 criteria, all the patients who met any of the SCHOLAR-1 criteria at any time were included to assess whether these criteria have the same prognostic impact in the CAR-T era. In addition, patients were grouped according to whether they were refractory to the first line of treatment, refractory to the last line of treatment, or relapsed early after auto-SCT. The PFS and OS were calculated from the time of appearance of the SCHOLAR-1 refractoriness criteria. Of 329 patients treated with CAR-T (169 with axi-cel and 160 with tisa-cel), 52 were in the non-SCHOLAR-1 group and 277 were in the SCHOLAR-1 group. We found significantly better outcomes in the non-SCHOLAR-1 patients compared with the SCHOLAR-1 patients (median PFS of 12.2 and 3.3 months, respectively; P = .009). In addition, axi-cel showed better results in terms of efficacy than tisa-cel for both the non-SCHOLAR-1 group (hazard ratio [HR] for PFS, 2.7 [95% confidence interval (CI), 1.1 to 6.7; P = .028]; HR for OS, 7.1 [95% CI, 1.5 to 34.6; P = .015]) and SCHOLAR-1 group (HR for PFS, 1.8 [95% CI, 1.3 to 2.5; P < .001]; HR for OS, 1.8 [95% CI, 1.2 to 2.6; P = .002]), but also significantly more toxicity. Finally, separately analyzing the prognostic impact of each SCHOLAR-1 criterion revealed that refractoriness to the last line of treatment was the variable with the most significant impact on survival. In conclusion, SCHOLAR-1 refractoriness criteria notably influence the efficacy of CAR-T therapy. In our experience, axi-cel showed better efficacy than tisa-cel for both SCHOLAR-1 and non-SCHOLAR-1 patients. Refractoriness to the last line of treatment was the variable with the most significant impact on survival in the CAR-T therapy era.
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Affiliation(s)
- Mariana Bastos-Oreiro
- Hospital Universitario Gregorio Maran, Instituto de investigación sanitaria Gregorio Marañon (IisGM), Madrid, Spain.
| | - Antonio Gutierrez
- Hospital Universitario Son Espases, IdISBa, Palma de Mallorca, Spain
| | | | - Lucía López Corral
- Hospital Clínico Universitario de Salamanca, IBSAL, CIBERONC, Salamanca, Spain
| | | | | | | | | | - Rafael Hernani
- Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | | | - Rebeca Bailen
- Hospital Universitario Gregorio Maran, Instituto de investigación sanitaria Gregorio Marañon (IisGM), Madrid, Spain
| | - Ignacio Gomez-Centurión
- Hospital Universitario Gregorio Maran, Instituto de investigación sanitaria Gregorio Marañon (IisGM), Madrid, Spain
| | - Ana Caballero
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jaime Sanz
- Hospital Universitario La Fé de Valencia, Balencia, Spain
| | | | - Hugo Luzardo
- Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | - Alberto Mussetti
- Institut Català d'Oncologia-Hospitalet, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Anna Sureda
- Institut Català d'Oncologia-Hospitalet, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | | | - Pere Barba
- Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - Mi Kwon
- Hospital Universitario Gregorio Maran, Instituto de investigación sanitaria Gregorio Marañon (IisGM), Madrid, Spain
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40
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Lemoine J, Bachy E, Cartron G, Beauvais D, Gastinne T, Di Blasi R, Rubio MT, Guidez S, Mohty M, Casasnovas RO, Joris M, Castilla-Llorente C, Haioun C, Hermine O, Loschi M, Carras S, Bories P, Fradon T, Herbaux C, Sesques P, Le Gouill S, Morschhauser F, Thieblemont C, Houot R. Nonrelapse mortality after CAR T-cell therapy for large B-cell lymphoma: a LYSA study from the DESCAR-T registry. Blood Adv 2023; 7:6589-6598. [PMID: 37672383 PMCID: PMC10641092 DOI: 10.1182/bloodadvances.2023010624] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 09/08/2023] Open
Abstract
CD19 chimeric antigen receptor (CAR) T cells can induce prolonged remissions and potentially cure a significant proportion of patients with relapsed/refractory large B-cell lymphomas. However, some patients may die of causes unrelated to lymphoma after CAR T-cell therapy. To date, little is known about the nonrelapse mortality (NRM) after CAR T-cell therapy. Using the French DESCAR-T registry, we analyzed the incidence and causes of NRM and identified risk factors of NRM. We report on 957 patients who received standard-of-care axicabtagene ciloleucel (n = 598) or tisagenlecleucel (n = 359) between July 2018 and April 2022, in 27 French centers. With a median follow-up of 12.4 months, overall NRM occurred in 48 patients (5.0% of all patients): early (before day 28 after infusion) in 9 patients (0.9% of all patients and 19% of overall NRM), and late (on/after day 28 after infusion) in 39 patients (4.1% of all patients and 81% of overall NRM). Causes of overall NRM were distributed as follows: 56% infections (29% with non-COVID-19 and 27% with COVID-19), 10% cytokine release syndromes, 6% stroke, 6% cerebral hemorrhage, 6% second malignancies, 4% immune effector cell associated neurotoxicities, and 10% deaths from other causes. We report risk factors of early NRM and overall NRM. In multivariate analysis, both diabetes and elevated ferritin level at lymphodepletion were associated with an increased risk of overall NRM. Our results may help physicians in patient selection and management in order to reduce the NRM after CAR T-cell therapy.
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Affiliation(s)
- Jean Lemoine
- Department of Hematology, CHU de Rennes, Rennes, France
| | - Emmanuel Bachy
- Department of Hematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Benite, France
| | | | | | | | - Roberta Di Blasi
- Department of Hemato-Oncology, Saint Louis Hospital, Paris, France
| | | | | | - Mohamad Mohty
- Department of Hematology, Saint Antoine Hospital, Paris, France
| | | | - Magalie Joris
- Department of Hematology, CHU d’Amiens, Amiens, France
| | - Cristina Castilla-Llorente
- Department of Hematology and INSERM, UMR 1030, Université Paris-Saclay, Gustave Roussy Cancer Campus Grand Paris, Paris, France
| | - Corinne Haioun
- Lymphoid Malignancies, Henri Mondor Hospital, Créteil, France
| | | | | | - Sylvain Carras
- Department of Hematology, CHU de Grenoble, Grenoble, France
| | - Pierre Bories
- Hematology Laboratory, Onco-occitanie Network, Toulouse University Institute of Cancer-Oncopole, Toulouse, France
| | - Tom Fradon
- LYSARC, The Lymphoma Academic Research Organisation, Lyon-Sud Hospital, Pierre-Benite, France
| | - Charles Herbaux
- Department of Hematology, CHU de Montpellier, Montpellier, France
| | - Pierre Sesques
- Department of Hematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Benite, France
| | | | | | | | - Roch Houot
- Department of Hematology, CHU de Rennes, Rennes, France
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Lionel AC, Westin J. Evolving Role of CAR T Cell Therapy in First- and Second-Line Treatment of Large B Cell Lymphoma. Curr Oncol Rep 2023; 25:1387-1396. [PMID: 37861914 DOI: 10.1007/s11912-023-01466-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE OF REVIEW We review the recent practice-changing trials of anti-CD19 chimeric antigen receptor (CAR) T cell therapies in large B cell lymphoma (LBCL) including phase 3 comparisons with second-line standard-of-care (SOC) and phase 2 investigations in transplant-ineligible patients or as part of first-line treatment. RECENT FINDINGS ZUMA-7 found significantly improved overall survival and event-free survival (EFS) with axicabtagene ciloleucel (axi-cel) versus SOC of salvage chemotherapy followed by autologous stem-cell transplantation. This represents the first such survival improvement in nearly 30 years for early-relapsed or refractory (r/r) LBCL. TRANSFORM demonstrated prolonged EFS for lisocabtagene maraleucel (liso-cel) versus SOC but BELINDA did not for tisagenlecleucel. Second-line CAR T cell was a viable curative-intent therapy in elderly (ZUMA-7; axi-cel) and/or transplant-ineligible (PILOT; liso-cel) patients. ZUMA-12 demonstrated effectiveness for axi-cel as part of first-line treatment for high-risk LBCL. These results support a role for CAR T cell therapy as new second-line SOC for r/r LBCL and highlight its potential evolution into future first-line treatment for high-risk disease.
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Affiliation(s)
- Anath C Lionel
- Division of Cancer Medicine, Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jason Westin
- Division of Cancer Medicine, Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Ryan CE, Jacobson CA. Effective sequencing of chimeric antigen receptor T-cell therapy in the treatment of LBCL in 2023. Semin Hematol 2023; 60:322-328. [PMID: 38199906 DOI: 10.1053/j.seminhematol.2023.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 01/12/2024]
Abstract
Over the last decade, CD19-targeting chimeric antigen receptor (CAR) T-cell therapy has profoundly changed the management of relapsed/refractory large-B-cell lymphoma (LBCL). At present, there are three FDA-approved anti-CD19 CAR T-cell products for LBCL: axicabtagene ciloleucel (axi-cel), lisocabtagene maraleucel (liso-cel), and tisagenlecleucel (tisa-cel). Two of these (axi-cel & liso-cel) are approved for use in the second-line setting under certain conditions. As CAR T-cell therapy continues to define a new role in the treatment armamentarium for LBCL, questions remain regarding which product to use and how to sequence CAR T-cell therapy with other therapeutic options. Here we will briefly review the key features of each FDA-approved anti-CD19 CAR T-cell product and the data that led to regulatory approval for each. Next, we will focus on the recent landmark studies that have established the use of CAR T-cell therapy as second-line treatment. While no direct prospective head-to-head comparisons exist of the 3 constructs, we will review some retrospective studies that suggest some emerging differences between the products. Lastly, we will turn our attention to the horizon as we explore some of the ongoing questions of how to best leverage the curative potential of CAR T-cell therapy for the most effective management of LBCL. These areas include the consideration of CAR T-cell therapy in the frontline setting, the optimal timing for CAR T-cell referral, the optimal bridging approach, and how to continue advancing novel CAR T-cell approaches in the context of the current treatment landscape.
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Affiliation(s)
- Christine E Ryan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Caron A Jacobson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.
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Ong SY, Pak S, Mei M, Wang Y, Popplewell L, Baird JH, Herrera AF, Shouse G, Nikolaenko L, Zain J, Godfrey J, Htut M, Aribi A, Spielberger R, Mansour J, Forman SJ, Palmer J, Budde LE. Bendamustine lymphodepletion is a well-tolerated alternative to fludarabine and cyclophosphamide lymphodepletion for axicabtagene ciloleucel therapy for aggressive B-cell lymphoma. Am J Hematol 2023; 98:1751-1761. [PMID: 37668287 PMCID: PMC10666914 DOI: 10.1002/ajh.27069] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/28/2023] [Accepted: 08/14/2023] [Indexed: 09/06/2023]
Abstract
Fludarabine/cyclophosphamide (Flu/Cy) is established for lymphodepletion (LD) prior to standard-of-care CAR T-cell therapy for lymphoma. There is ongoing need to test alternative LD regimens to preserve efficacy, improve safety, and address challenges including the recent national fludarabine shortage. We retrospectively evaluated outcomes among patients with relapsed/refractory aggressive B-cell lymphoma who received bendamustine (n = 27) or Flu/Cy (n = 42) LD before axicabtagene ciloleucel (axi-cel) at our institution. The median change in absolute lymphocyte count from pre-LD to time of axi-cel infusion was -0.6×109 /L in bendamustine cohort and -0.7×109 /L in Flu/Cy cohort. The best overall response/complete response rates were 77.8% (95% CI: 57.7%-91.4%)/48.1% (95% CI: 28.7%-68.1%) among bendamustine cohort and 81.0% (95% CI: 65.9%-91.4%)/50.0% (95% CI: 34.2%-65.8%) among Flu/Cy cohort. Six-month progression-free survival were 43.8% (95% CI: 24.7%-61.3%) and 55.6% (95% CI: 39.0%-69.3%) in bendamustine and Flu/Cy cohorts, while 6-month overall survival were 81.5% (95% CI: 61.1%-91.8%) and 90.4% (95% CI: 76.4%-96.3%), respectively. Relative to Flu/Cy-treated patients, bendamustine-treated patients did not show an increase in hazards associated with experiencing progression/relapse/death (aHR:1.4 [95% CI: 0.7-2.8]; p = .32) or death (aHR:1.6 [95% CI: 0.5-5.6]; p = .46), after adjusting for baseline number of prior therapies and refractory disease. Any grade/grade ≥3 CRS were observed in 89%/3.7% and 86%/4.8% among bendamustine and Flu/Cy cohorts, while any grade ICANS/grade ≥3 ICANS were observed in 30%/19% and 55%/31% respectively. While more Flu/Cy-treated patients experienced grade ≥3 neutropenia compared with bendamustine-treated patients (100% vs. 68%), grade ≥3 infectious complications were comparable (24% vs. 19% respectively). More patients received bendamustine LD and axi-cel as outpatient than Flu/Cy cohort, without increased toxicities and with shorter median inpatient stays. In conclusion, we observed comparable efficacy and lower any grade ICANS among patients receiving bendamustine relative to Flu/Cy LD, followed by axi-cel.
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Affiliation(s)
- Shin Yeu Ong
- Contribute equally
- Department of Hematology/ Hematopoietic Cell Transplantation, City of Hope National Medical Center
- Department of Hematology. Singapore General Hospital, Singapore
| | - Stacy Pak
- Contribute equally
- Department of Hematology/ Hematopoietic Cell Transplantation, City of Hope National Medical Center
| | - Matthew Mei
- Contribute equally
- Department of Hematology/ Hematopoietic Cell Transplantation, City of Hope National Medical Center
| | - Yan Wang
- Department of Computational and Quantitative Medicine, Division of Biostatistics, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - Leslie Popplewell
- Department of Hematology/ Hematopoietic Cell Transplantation, City of Hope National Medical Center
| | - John H Baird
- Department of Hematology/ Hematopoietic Cell Transplantation, City of Hope National Medical Center
| | - Alex F. Herrera
- Department of Hematology/ Hematopoietic Cell Transplantation, City of Hope National Medical Center
| | - Geoffrey Shouse
- Department of Hematology/ Hematopoietic Cell Transplantation, City of Hope National Medical Center
| | - Liana Nikolaenko
- Department of Hematology/ Hematopoietic Cell Transplantation, City of Hope National Medical Center
| | - Jasmine Zain
- Department of Hematology/ Hematopoietic Cell Transplantation, City of Hope National Medical Center
| | - James Godfrey
- Department of Hematology/ Hematopoietic Cell Transplantation, City of Hope National Medical Center
| | - Myo Htut
- Department of Hematology/ Hematopoietic Cell Transplantation, City of Hope National Medical Center
| | - Ahmed Aribi
- Department of Hematology/ Hematopoietic Cell Transplantation, City of Hope National Medical Center
| | - Ricardo Spielberger
- Department of Hematology/ Hematopoietic Cell Transplantation, City of Hope National Medical Center
- Department of Bone Marrow Transplant, Southern California Kaiser Permanente, Los Angeles, California
| | - Joshua Mansour
- Department of Hematology/ Hematopoietic Cell Transplantation, City of Hope National Medical Center
- Department of Bone Marrow Transplant, Southern California Kaiser Permanente, Los Angeles, California
| | - Stephen J. Forman
- Department of Hematology/ Hematopoietic Cell Transplantation, City of Hope National Medical Center
| | - Joycelynne Palmer
- Department of Computational and Quantitative Medicine, Division of Biostatistics, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - Lihua E Budde
- Department of Hematology/ Hematopoietic Cell Transplantation, City of Hope National Medical Center
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Medina I, Carpio C, Ruiz-Camps I, Albasanz-Puig A, Lopez-Godino O, Esperalba J, Beas F, Sanchez-Salinas M, Iacoboni G, Barba P. Adenovirus-induced hemorrhagic cystitis after CD19-targeted chimeric antigen receptor T-cell therapy in a patient with large B-cell lymphoma. Immunotherapy 2023; 15:1369-1374. [PMID: 37718888 DOI: 10.2217/imt-2023-0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Chimeric antigen receptor (CAR) T cells targeting CD19 have changed the treatment landscape of patients with relapsed/refractory diffuse large B-cell lymphoma. Infections are one of the most frequent complications after CAR T-cell therapy. Most of these infections are bacterial, although viral infections can also occur in this setting. Adenovirus-induced hemorrhagic cystitis is a rare infectious complication and is usually observed after bone marrow or solid organ transplantation. Herein we report a case of adenovirus-induced hemorrhagic cystitis in a patient experiencing urinary symptoms within the first month after CAR T-cell infusion. Based on our experience and a literature review, we discuss the diagnostic approach and potential treatment options for this infrequent infection after CAR T-cell therapy.
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Affiliation(s)
- Irene Medina
- Department of Hematology, Experimental Hematology, Vall d'Hebron Institute of Oncology, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
| | - Cecilia Carpio
- Department of Hematology, Experimental Hematology, Vall d'Hebron Institute of Oncology, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
| | - Isabel Ruiz-Camps
- Department of Medicine, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
- Department of Infectious Diseases, Vall d'Hebron Research Institute, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
| | - Adaia Albasanz-Puig
- Department of Medicine, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
- Department of Infectious Diseases, Vall d'Hebron Research Institute, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
| | - Oriana Lopez-Godino
- Department of Hematology, Hospital Universitario Morales Meseguer, 30008, Murcia, Spain
| | - Juliana Esperalba
- Department of Microbiology, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
| | - Francisco Beas
- Department of Hematology, Experimental Hematology, Vall d'Hebron Institute of Oncology, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
| | - Mario Sanchez-Salinas
- Department of Hematology, Experimental Hematology, Vall d'Hebron Institute of Oncology, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
| | - Gloria Iacoboni
- Department of Hematology, Experimental Hematology, Vall d'Hebron Institute of Oncology, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
| | - Pere Barba
- Department of Hematology, Experimental Hematology, Vall d'Hebron Institute of Oncology, University Hospital Vall d'Hebron, 08035, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
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45
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Gurumurthi A, Westin J, Subklewe M. The race is on: bispecifics vs CAR T cells in B-cell lymphoma. Blood Adv 2023; 7:5713-5716. [PMID: 37037004 PMCID: PMC10539863 DOI: 10.1182/bloodadvances.2022009066] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/30/2023] [Accepted: 04/02/2023] [Indexed: 04/12/2023] Open
Affiliation(s)
- Ashwath Gurumurthi
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jason Westin
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marion Subklewe
- Gene Center and Department of Biochemistry, Ludwig-Maximilians-Universität München, Munich, Germany
- Department of Medicine II, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
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46
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Kambhampati S, Shouse G, Danilov AV. Thinking "outside the germinal center": Re-educating T cells to combat follicular lymphoma. Blood Rev 2023; 61:101099. [PMID: 37173225 DOI: 10.1016/j.blre.2023.101099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/04/2023] [Accepted: 05/08/2023] [Indexed: 05/15/2023]
Abstract
There have been significant advancements in the management of follicular lymphoma (FL), the most common indolent lymphoma. These include immunomodulatory agents such as lenalidomide, epigenetic modifiers (tazemetostat), and phosphoinotiside-3 kinase inhibitors (copanlisib). The focus of this review is T cell-engager therapies, namely chimeric antigen receptor (CAR) T-cell therapy and bispecific antibodies, have recently transformed the treatment landscape of FL. Two CAR T cell products, axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel), and one bispecific antibody, mosunetuzumab, recently received FDA approvals in FL. Several other new immune effector drugs are being evaluated and will expand the treatment armamentarium. This review focuses on CAR T-cell and bispecific antibody therapies, details their safety and efficacy and considers their evolving role in the current treatment landscape of FL.
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47
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Terao T, Kitamura W, Fujii N, Asada N, Kamoi C, Fujiwara K, Kondo K, Matsubara C, Hayashino K, Seike K, Fujiwara H, Ennishi D, Nishimori H, Fujii K, Matsuoka KI, Maeda Y. Negative Prognostic Impact of High-Dose or Long-Term Corticosteroid Use in Patients with Relapsed or Refractory B-Cell Lymphoma Who Received Tisagenlecleucel. Transplant Cell Ther 2023; 29:573.e1-573.e8. [PMID: 37394114 DOI: 10.1016/j.jtct.2023.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/12/2023] [Accepted: 06/28/2023] [Indexed: 07/04/2023]
Abstract
The prognostic impact of corticosteroid therapy in patients receiving tisagenlecleucel (tisa-cel) treatment who are more likely to develop cytokine release syndrome (CRS) remains unclear. This study aimed to evaluate the clinical impact and lymphocyte kinetics of corticosteroid administration for CRS in 45 patients with relapsed and/or refractory B-cell lymphoma treated with tisa-cel. This was a retrospective evaluation of all consecutive patients diagnosed with relapsed and/or refractory diffuse large B-cell lymphoma, follicular lymphoma with histologic transformation to large B-cell lymphoma, or follicular lymphoma who received commercial-based tisa-cel treatment. The best overall response rate, complete response rate, median progression-free survival (PFS), and median overall survival (OS) were 72.7%, 45.5%, 6.6 months, and 15.3 months, respectively. CRS (predominantly grade 1/2) occurred in 40 patients (88.9%), and immune effector cell-associated neurotoxicity syndrome (ICANS) of all grades occurred in 3 patients (6.7%). No grade ≥3 ICANS occurred. Patients with high-dose (≥524 mg, methylprednisolone equivalent; n = 12) or long-term (≥8 days; n = 9) corticosteroid use had inferior PFS and OS to patients with low-dose or no corticosteroid use (both P < .05). The prognostic impact remained even in 23 patients with stable disease (SD) or progressive disease (PD) before tisa-cel infusion (P = .015). but not in patients with better disease status (P = .71). The timing of corticosteroid initiation did not have a prognostic impact. Multivariate analysis identified high-dose corticosteroid use and long-term corticosteroid use as independent prognostic factors for PFS and OS, respectively, after adjusting for elevated lactate dehydrogenase level before lymphodepletion chemotherapy and disease status (SD or PD). Lymphocyte kinetics analysis demonstrated that after methylprednisolone administration, the proportions of regulatory T cells (Tregs), CD4+ central memory T (TCM) cells, and natural killer (NK) cells were decreased, whereas the proportion of CD4+ effector memory T (TEM) cells was increased. Patients with a higher proportion of Tregs at day 7 had a lower incidence of CRS, but this did not affect prognosis, indicating that early elevation of Tregs may serve as a biomarker for CRS development. Furthermore, patients with higher numbers of CD4+ TCM cells and NK cells at various time points had significantly better PFS and OS, whereas the number of CD4+ TEM cells did not impact prognostic outcomes. This study suggests that high-dose or long-term corticosteroid use attenuates the efficacy of tisa-cel, especially in patients with SD or PD. Additionally, patients with high levels of CD4+ TCM cells and NK cells after tisa-cel infusion had longer PFS and OS.
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Affiliation(s)
- Toshiki Terao
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan; Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Wataru Kitamura
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan; Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Nobuharu Fujii
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan; Division of Blood Transfusion, Okayama University Hospital, Okayama, Japan.
| | - Noboru Asada
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Chihiro Kamoi
- Division of Blood Transfusion, Okayama University Hospital, Okayama, Japan
| | - Kanako Fujiwara
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Kaho Kondo
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Chisato Matsubara
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Kenta Hayashino
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Keisuke Seike
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Hideaki Fujiwara
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Daisuke Ennishi
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Hisakazu Nishimori
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Keiko Fujii
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan; Division of Clinical Laboratory, Okayama University Hospital, Okayama, Japan
| | - Ken-Ichi Matsuoka
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Yoshinobu Maeda
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan; Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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48
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Spanjaart AM, Pennings ERA, Mutsaers PGNJ, van Dorp S, Jak M, van Doesum JA, de Boer JW, Niezink AGH, Kos M, Vermaat JSP, Sijs-Szabo A, van der Poel MWM, Nijhof IS, Kuipers MT, Chamuleau MED, Lugtenburg PJ, Doorduijn JK, Serroukh YIM, Minnema MC, van Meerten T, Kersten MJ. The Dutch CAR-T Tumorboard Experience: Population-Based Real-World Data on Patients with Relapsed or Refractory Large B-Cell Lymphoma Referred for CD19-Directed CAR T-Cell Therapy in The Netherlands. Cancers (Basel) 2023; 15:4334. [PMID: 37686611 PMCID: PMC10486925 DOI: 10.3390/cancers15174334] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/01/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
The real-world results of chimeric antigen receptor T-cell (CAR-T) therapy for patients with relapsed/refractory (R/R) large B-cell lymphoma (LBCL) substantially differ across countries. In the Netherlands, the CAR-T tumorboard facilitates a unique nationwide infrastructure for referral, eligibility assessment and data collection. The aim of this study was to evaluate real-world outcomes of axicabtagene ciloleucel (axi-cel) in the Dutch population, including the thus-far underreported effects on health-related quality of life (HR-QoL). All patients with R/R LBCL after ≥2 lines of systemic therapy referred for axi-cel treatment between May 2020-May 2022 were included (N = 250). Of the 160 apheresed patients, 145 patients received an axi-cel infusion. The main reason for ineligibility was rapidly progressive disease. The outcomes are better or at least comparable to other studies (best overall response rate: 84% (complete response: 66%); 12-month progression-free-survival rate and overall survival rate: 48% and 62%, respectively). The 12-month NRM was 5%, mainly caused by infections. Clinically meaningful improvement in several HR-QoL domains was observed from Month 9 onwards. Expert-directed patient selection can support effective and sustainable application of CAR-T treatment. Matched comparisons between cohorts will help to understand the differences in outcomes across countries and select best practices. Despite the favorable results, for a considerable proportion of patients with R/R LBCL there still is an unmet medical need.
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Affiliation(s)
- Anne M. Spanjaart
- Department of Hematology, Amsterdam UMC Location University of Amsterdam, 1007 MB Amsterdam, The Netherlands
- Cancer Center Amsterdam, 1105 AZ Amsterdam, The Netherlands
- LYMMCARE (Lymphoma and Myeloma Center Amsterdam), 1105 AZ Amsterdam, The Netherlands
| | - Elise R. A. Pennings
- Department of Hematology, Amsterdam UMC Location University of Amsterdam, 1007 MB Amsterdam, The Netherlands
- Cancer Center Amsterdam, 1105 AZ Amsterdam, The Netherlands
- LYMMCARE (Lymphoma and Myeloma Center Amsterdam), 1105 AZ Amsterdam, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands
| | - Pim G. N. J. Mutsaers
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Suzanne van Dorp
- Department of Hematology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Margot Jak
- Department of Hematology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Jaap A. van Doesum
- Department of Hematology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Janneke W. de Boer
- Department of Hematology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Anne G. H. Niezink
- Department of Radiation Oncology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Milan Kos
- Cancer Center Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Joost S. P. Vermaat
- Department of Hematology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Aniko Sijs-Szabo
- Department of Hematology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Marjolein W. M. van der Poel
- Department of Internal Medicine, Division of Hematology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
| | - Inger S. Nijhof
- Cancer Center Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Internal Medicine-Hematology, St Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
| | - Maria T. Kuipers
- Cancer Center Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Martine E. D. Chamuleau
- Cancer Center Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Pieternella J. Lugtenburg
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Jeanette K. Doorduijn
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Yasmina I. M. Serroukh
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Monique C. Minnema
- Department of Hematology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Tom van Meerten
- Department of Hematology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Marie José Kersten
- Department of Hematology, Amsterdam UMC Location University of Amsterdam, 1007 MB Amsterdam, The Netherlands
- Cancer Center Amsterdam, 1105 AZ Amsterdam, The Netherlands
- LYMMCARE (Lymphoma and Myeloma Center Amsterdam), 1105 AZ Amsterdam, The Netherlands
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49
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Bücklein V, Perez A, Rejeski K, Iacoboni G, Jurinovic V, Holtick U, Penack O, Kharboutli S, Blumenberg V, Ackermann J, Frölich L, Johnson G, Patel K, Arciola B, Mhaskar R, Wood A, Schmidt C, Albanyan O, Gödel P, Hoster E, Bullinger L, Mackensen A, Locke F, von Bergwelt M, Barba P, Subklewe M, Jain MD. Inferior Outcomes of EU Versus US Patients Treated With CD19 CAR-T for Relapsed/Refractory Large B-cell Lymphoma: Association With Differences in Tumor Burden, Systemic Inflammation, Bridging Therapy Utilization, and CAR-T Product Use. Hemasphere 2023; 7:e907. [PMID: 37449196 PMCID: PMC10337711 DOI: 10.1097/hs9.0000000000000907] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/03/2023] [Indexed: 07/18/2023] Open
Abstract
Real-world evidence suggests a trend toward inferior survival of patients receiving CD19 chimeric antigen receptor (CAR) T-cell therapy in Europe (EU) and with tisagenlecleucel. The underlying logistic, patient- and disease-related reasons for these discrepancies remain poorly understood. In this multicenter retrospective observational study, we studied the patient-individual journey from CAR-T indication to infusion, baseline features, and survival outcomes in 374 patients treated with tisagenlecleucel (tisa-cel) or axicabtagene-ciloleucel (axi-cel) in EU and the United States (US). Compared with US patients, EU patients had prolonged indication-to-infusion intervals (66 versus 50 d; P < 0.001) and more commonly received intermediary therapies (holding and/or bridging therapy, 94% in EU versus 74% in US; P < 0.001). Baseline lactate dehydrogenase (LDH) (median 321 versus 271 U/L; P = 0.02) and ferritin levels (675 versus 425 ng/mL; P = 0.004) were significantly elevated in the EU cohort. Overall, we observed inferior survival in EU patients (median progression-free survival [PFS] 3.1 versus 9.2 months in US; P < 0.001) and with tisa-cel (3.2 versus 9.2 months with axi-cel; P < 0.001). On multivariate Lasso modeling, nonresponse to bridging, elevated ferritin, and increased C-reactive protein represented independent risks for treatment failure. Weighing these variables into a patient-individual risk balancer (high risk [HR] balancer), we found higher levels in EU versus US and tisa-cel versus axi-cel cohorts. Notably, superior PFS with axi-cel was exclusively evident in patients at low risk for progression (according to the HR balancer), but not in high-risk patients. These data demonstrate that inferior survival outcomes in EU patients are associated with longer time-to-infusion intervals, higher tumor burden/LDH levels, increased systemic inflammatory markers, and CAR-T product use.
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Affiliation(s)
- Veit Bücklein
- Department of Medicine III, University Hospital, LMU Munich, Germany
- Laboratory for Translational Cancer Immunology, LMU Gene Center, Munich, Germany
| | - Ariel Perez
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
- Blood and Marrow Transplant Program, Miami Cancer Institute, Miami, FL, USA
| | - Kai Rejeski
- Department of Medicine III, University Hospital, LMU Munich, Germany
- Laboratory for Translational Cancer Immunology, LMU Gene Center, Munich, Germany
- German Cancer Consortium (DKTK) Munich Site, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gloria Iacoboni
- Department of Hematology, Vall d’Hebron Institute of Oncology (VHIO), University Hospital Vall d’Hebron, Department of Medicine, Universitat Autònoma of Barcelona (UAB), Spain
| | - Vindi Jurinovic
- Institute for Medical Information Processing, Biometry, and Epidemiology, LMU Munich, Germany
| | - Udo Holtick
- Department I of Internal Medicine, Medical Faculty and University Hospital, Cologne, University of Cologne, Germany
| | - Olaf Penack
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology and Tumorimmunology, Berlin, Germany
| | - Soraya Kharboutli
- Department of Internal Medicine 5, Hematology and Oncology, University of Erlangen-Nuremberg, Germany
| | - Viktoria Blumenberg
- Department of Medicine III, University Hospital, LMU Munich, Germany
- Laboratory for Translational Cancer Immunology, LMU Gene Center, Munich, Germany
- German Cancer Consortium (DKTK) Munich Site, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Lisa Frölich
- Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Grace Johnson
- USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Kedar Patel
- USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Brian Arciola
- USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Rahul Mhaskar
- USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Anthony Wood
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Christian Schmidt
- Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Omar Albanyan
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Philipp Gödel
- Department I of Internal Medicine, Medical Faculty and University Hospital, Cologne, University of Cologne, Germany
| | - Eva Hoster
- Institute for Medical Information Processing, Biometry, and Epidemiology, LMU Munich, Germany
| | - Lars Bullinger
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology and Tumorimmunology, Berlin, Germany
| | - Andreas Mackensen
- Department of Internal Medicine 5, Hematology and Oncology, University of Erlangen-Nuremberg, Germany
| | - Frederick Locke
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Michael von Bergwelt
- Department of Medicine III, University Hospital, LMU Munich, Germany
- German Cancer Consortium (DKTK) Munich Site, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Pere Barba
- Department of Hematology, Vall d’Hebron Institute of Oncology (VHIO), University Hospital Vall d’Hebron, Department of Medicine, Universitat Autònoma of Barcelona (UAB), Spain
| | - Marion Subklewe
- Department of Medicine III, University Hospital, LMU Munich, Germany
- Laboratory for Translational Cancer Immunology, LMU Gene Center, Munich, Germany
- German Cancer Consortium (DKTK) Munich Site, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael D. Jain
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
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50
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Lin RJ, Kim SJ, Brown S, Elko TA, Ruiz JD, Hanley DM, Lia Palomba M, Perales MA, Shah GL, Dahi PB, Scordo M, Sauter CS, Batlevi CL, Tomas AA, Shouval R, Lee N, Pavkovic EA, Engstler DE, Park JH, Salles GA, Devlin SM, Korc-Grodzicki B, Hamlin PA, Giralt SA. Prospective geriatric assessment and geriatric consultation in CAR T-cell therapy for older patients with lymphoma. Blood Adv 2023; 7:3501-3505. [PMID: 37078703 PMCID: PMC10362256 DOI: 10.1182/bloodadvances.2023010003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/27/2023] [Accepted: 04/12/2023] [Indexed: 04/21/2023] Open
Affiliation(s)
- Richard J. Lin
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Soo Jung Kim
- Geriatrics Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samantha Brown
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Theresa A. Elko
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Josel D. Ruiz
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Danielle M. Hanley
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M. Lia Palomba
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Miguel-Angel Perales
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Gunjan L. Shah
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Parastoo B. Dahi
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Michael Scordo
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Craig S. Sauter
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Connie L. Batlevi
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ana Alarcon Tomas
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Roni Shouval
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Nicole Lee
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Emma A. Pavkovic
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Danielle E. Engstler
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jae H. Park
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Gilles A. Salles
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sean M. Devlin
- Weill Cornell Medical College, New York, NY
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Beatriz Korc-Grodzicki
- Weill Cornell Medical College, New York, NY
- Geriatrics Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul A. Hamlin
- Weill Cornell Medical College, New York, NY
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sergio A. Giralt
- Adult Blood and Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
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