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Hu B, Korsos V, Palomba ML. Chimeric antigen receptor T-cell therapy for aggressive B-cell lymphomas. Front Oncol 2024; 14:1394057. [PMID: 39011476 PMCID: PMC11246842 DOI: 10.3389/fonc.2024.1394057] [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: 02/29/2024] [Accepted: 05/21/2024] [Indexed: 07/17/2024] Open
Abstract
Chimeric antigen receptor (CAR) T-cell therapy is a revolutionary approach in the treatment of lymphoma. This review article provides an overview of the four FDA-approved CAR T-cell products for aggressive B-cell lymphoma, including diffuse large B-cell lymphoma and mantle cell lymphoma, highlighting their efficacy and toxicity as well as discussing future directions.
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Affiliation(s)
- Bei Hu
- Department of Hematologic Oncology and Blood Disorders, Atrium Health Levine Cancer Institute/Wake Forest School of Medicine, Charlotte, NC, United States
| | - Victoria Korsos
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - M Lia Palomba
- Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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2
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Yu W, Huang L, Mei H, Li Y, Niu T, Zou D, Liu Y, Zhang H, Liu P, Wu J, Wang Z, Li H, Cai Q, Mi JQ. Real-world experience of commercial relmacabtagene autoleucel (relma-cel) for relapsed/refractory central nervous system lymphoma: a multicenter retrospective analysis of patients in China. J Immunother Cancer 2024; 12:e008553. [PMID: 38802271 PMCID: PMC11131121 DOI: 10.1136/jitc-2023-008553] [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: 05/13/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Relapsed/refractory (R/R) central nervous system lymphomas (CNSLs) are associated with a poor prognosis. Relmacabtagene autoleucel (relma-cel), expressing the same chimeric antigen receptor (CAR) as lisocabtagene maraleucel, with an optimized commercial-ready process developed in China, demonstrated remarkable efficacy and manageable safety in the pivotal RELIANCE study. However, no published data are available on the "real-world" use of relma-cel, especially for patients with CNS involvement. PATIENTS AND METHODS Retrospective analyses were conducted for commercial relma-cel used in patients with R/R CNSL at 12 clinics. The primary endpoint was to evaluate the proportion of patients who achieved complete response (CR) at 3 months. Secondary endpoints included best complete response (BCR), progression-free survival (PFS), duration of response (DOR), overall survival (OS), and the incidence of adverse events. RESULTS Among the 22 CNSL patients (12 primary CNSLs; 10 secondary CNSLs), the best overall response rate was 90.9% and the BCR rate was 68.2%. With median follow-up of 316 days (range, 55-618 days), the estimated 1-year PFS rate, DOR, and OS rate were 64.4%, 71.5%, and 79.2%, respectively. Significant clinical benefits were observed in patients who were in durable CR or partial response to the most recent prior therapy preleukapheresis and received relma-cel as consolidation therapy (n=8), with 1-year PFS rate of 100.0% versus 41.7% (p=0.02). In addition, in terms of primary endpoint, non-CR at 3 months postinfusion seemed to be predictive of a worse prognosis, with an estimated 1-year PFS of 83.3% versus 37.0% (p=0.03), respectively. CRS occurred in 72.9% of patients (grade 3: 4.5%) and immune effector cell-associated neurotoxicity syndrome in 36.4% of patients (grade 3: 4.5%). With the add-on agent PD-1 inhibitor (tislelizumab) to the ongoing BTKi, significant re-expansions of CAR T-cell were detected by quantitative PCR or flow cytometry after a median of 2 weeks (range, 12-32 days). CONCLUSIONS This study was the first and largest real-world study of commercial relma-cel for R/R CNSL, demonstrating promising efficacy and acceptable safety. We reaffirmed the benefit of immuno-agents such as BTKi or PD-1 inhibitor on CAR T-cell re-expansion and hypothesized a dual-agent CAR-T related combinatorial therapies, which warrants further validation. Most importantly, we highlighted the earlier use of CAR T-cell therapy as a consolidative therapy for patients sensitive to salvage therapy, which provided an impetus and inspired-future strategy.
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Affiliation(s)
- Wenyan Yu
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liang Huang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Heng Mei
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuhua Li
- Department of Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Ting Niu
- Department of Hematology, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and National Collaborative Innovation Center, Chengdu, Sichuan, China
| | - Dehui Zou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjian, China
| | - Yao Liu
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Department of Hematology-Oncology, Chongqing University Cancer Hospital, Shapingba, Chongqing, China
| | - Huilai Zhang
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Peng Liu
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, Shanghai, China
| | - Jianqiu Wu
- Department of Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhi Wang
- Department of Hematology, Jiangnan University Medical Center, Wuxi, Jiangsu, China
| | - Hui Li
- Department of Hematology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Qingqing Cai
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Jian-Qing Mi
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Elgohary G, Yang Y, Gergis M, Yi D, Gergis U. Chimeric Antigen Receptor T - Cell Therapy for Large B-Cell Lymphoma Patients with Central Nervous System Involvement, a Systematic Review and Meta-analysis. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:e142-e151. [PMID: 38267353 DOI: 10.1016/j.clml.2023.12.012] [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: 11/02/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 01/26/2024]
Abstract
Chimeric Antigen Receptor T-cell (CAR T-cell) therapy is an effective treatment for relapsed/refractory (R/R) large B cell lymphoma (LBCL). However, patients with central nervous system (CNS) lymphoma were excluded in most of the CAR T-cell therapy trials. This meta-analysis assesses the efficacy with CAR T-cell therapy in LBCL patients with CNS involvement. Two reviewers independently searched PubMed and Cochrane Library to identify all published literature associated with United States Food and Drug Administration approved CAR T-cell therapies for LBCL. Patients with CNS LBCL were included. Meta-analysis of proportion was performed to evaluate the overall response (ORR), complete response (CR) for efficacy, and cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome for safety assessment. Nineteen studies were qualified for inclusion with 141 CNS LBCL patients. The ORR and CR rates were 61% and 55% respectively. The median overall survival (OS) was 8.8 months, and the median progression free survival (PFS) was 4.4 months. Severe immune effector cell-associated neurotoxicity syndrome (grade≥3) were reported in 25% (32/130) patients and severe cytokine release syndrome (grade≥3) were found in 10% (13/124) of the patients. The safety and efficacy of CAR T-cell therapy in CNS LBCL patients appears comparable to patients without CNS involvement.
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Affiliation(s)
| | - Yang Yang
- Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | | | | | - Usama Gergis
- Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA.
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Liu Y, Li Y, Yu Z, Wang R, Jing Y. Sequential autologous CAR-T and allogeneic CAR-T therapy successfully treats central nervous system involvement relapsed/refractory ALL: a case report and literature review. Front Oncol 2024; 14:1341682. [PMID: 38322417 PMCID: PMC10845664 DOI: 10.3389/fonc.2024.1341682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/02/2024] [Indexed: 02/08/2024] Open
Abstract
Background The central nervous system (CNS) is the most common site of extramedullary invasion in acute lymphoblastic leukemia (ALL), and involvement of the CNS is often associated with relapse, refractory disease, and poor prognosis. Chimeric antigen receptor-T (CAR-T) cell therapy, a promising modality in cancer immunotherapy, has demonstrated significant advantages in the treatment of hematological malignancies. However, due to associated adverse reactions such as nervous system toxicity, the safety and efficacy of CAR-T cell therapy in treating CNSL remains controversial, with limited reports available. Case report Here, we present the case of a patient with confirmed B-ALL who experienced relapse in both bone marrow (BM) and cerebrospinal fluid (CSF) despite multiple cycles of chemotherapy and intrathecal injections. The infusion of autologous CD19 CAR-T cells resulted in complete remission (CR) in both BM and CSF for 40 days. However, the patient later experienced a relapse in the bone marrow. Subsequently, allogeneic CD19 CAR-T cells derived from her brother were infused, leading to another achievement of CR in BM. Significantly, only grade 1 cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) events were detected during the treatment period and showed improvement with symptomatic management. During subsequent follow-up, the patient achieved a disease-free survival of 5 months and was successfully bridged to hematopoietic stem cell transplantation. Conclusion Our study provides support for the argument that CNS involvement should not be deemed an absolute contraindication to CAR-T cell therapy. With the implementation of suitable management and treatment strategies, CAR-T therapy can proficiently target tumor cells within the CNS. This treatment option may be particularly beneficial for relapsed or refractory patients, as well as those with central nervous system involvement who have shown limited response to conventional therapies. Additionally, CAR-T cell therapy may serve as a valuable bridge to allogeneic hematopoietic stem cell transplantation (allo-HSCT) in these patients.
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Affiliation(s)
| | | | | | | | - Yu Jing
- Medical School of Chinese PLA, Department of Hematology in the Fifth Medical Center of PLA General Hospital, Beijing, China
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Xia Y, Li X, Jiang N, Wei X. A novel Bruton's tyrosine kinase inhibitor JDB175 shows potent efficacy to suppress central nervous system lymphoma. MedComm (Beijing) 2023; 4:e424. [PMID: 37929016 PMCID: PMC10625055 DOI: 10.1002/mco2.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/13/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023] Open
Abstract
Patients with central nervous system (CNS) lymphoma face limited treatment options and poor treatment outcomes, emphasizing the urgent need for effective therapeutic strategies. One limiting factor contributing to the suboptimal efficacy is the inadequate penetration of most treatment drugs across the blood-brain barrier (BBB). Recent insights into the pathophysiology of CNS lymphoma have identified the Bruton's tyrosine kinase (BTK) signaling pathway as a potential target. Some clinical trials have shown impressive responses to BTK inhibitors in CNS lymphoma. However, currently approved BTK inhibitors have low BBB penetration rates, limiting their efficacy. In this study, we discovered that JDB175, a novel and highly selective BTK inhibitor, exhibits excellent BBB penetration capabilities and demonstrates favorable activity in a mouse model of CNS lymphoma while showing no significant signs of toxicity. JDB175 effectively inhibits the BTK signaling pathway in human lymphoma cells, suppressing their proliferation, inducing cell cycle arrest, and promoting apoptosis. The significance of this study lies in addressing the critical unmet medical need for effective treatments for CNS lymphoma. This finding indicates a promising avenue for improved treatments in CNS lymphoma, potentially opening doors for further clinical investigation and therapeutic advancements.
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Affiliation(s)
- Yong Xia
- Laboratory of Aging Research and Cancer Drug TargetState Key Laboratory of Biotherapy and Cancer CenterNational Clinical Research Center for GeriatricsWest China HospitalSichuan UniversityChengduChina
| | - Xue Li
- Laboratory of Aging Research and Cancer Drug TargetState Key Laboratory of Biotherapy and Cancer CenterNational Clinical Research Center for GeriatricsWest China HospitalSichuan UniversityChengduChina
| | - Ning Jiang
- Jumbo Drug Bank Co., Ltd., High‐Tech ZoneChengduChina
| | - Xiawei Wei
- Laboratory of Aging Research and Cancer Drug TargetState Key Laboratory of Biotherapy and Cancer CenterNational Clinical Research Center for GeriatricsWest China HospitalSichuan UniversityChengduChina
- Jumbo Drug Bank Co., Ltd., High‐Tech ZoneChengduChina
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Zou R, Zhou X, Liu H, Wang P, Xia F, Kang L, Yu L, Wu D, Jin Z, Qu C. Long-term Complete Remission of Decitabine-Primed Tandem CD19/CD22 CAR-T Therapy with PD-1 and BTK Inhibitors Maintenance in a Refractory Primary Central Nervous System Lymphoma Patient. Cancer Res Treat 2023; 55:1363-1368. [PMID: 37321275 PMCID: PMC10582536 DOI: 10.4143/crt.2023.371] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/01/2023] [Indexed: 06/17/2023] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare and aggressive non-Hodgkin's lymphoma that affects the brain, eyes, cerebrospinal fluid, or spinal cord without systemic involvement. The outcome of patients with PCNSL is worse compared to patients with systemic diffuse large B-cell lymphoma. Given potential mortality associated with severe immune effector cell-associated neurotoxicity syndrome (ICANS), patients with PCNSL have been excluded from most clinical trials involving chimeric antigen receptor T-cell (CAR-T) therapy initially. Here, we report for the first time to apply decitabine-primed tandem CD19/CD22 dual-targeted CAR-T therapy with programmed cell death-1 (PD-1) and Bruton's tyrosine kinase (BTK) inhibitors maintenance in one patient with multiline-resistant refractory PCNSL and the patient has maintained complete remission (CR) for a 35-month follow-up period. This case represents the first successful treatment of multiline resistant refractory PCNSL with long-term CR and without inducing ICANS under tandem CD19/CD22 bispecific CAR-T therapy followed by maintenance therapy with PD-1 and BTK inhibitors. This study shows tremendous potential in the treatment of PCNSL and offers a look toward ongoing clinical studies.
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Affiliation(s)
- Rui Zou
- College of Pharmaceutical Sciences Soochow University, The First Affiliated Hospital of Soochow University, Suzhou,
China
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou,
China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou,
China
| | - Xiao Zhou
- Department of Hematology & Oncology, Wuxi Taihu Lake Hospital, Wuxi,
China
| | - Hailing Liu
- Department of Radiology, People’s Hospital of Binhai County, Yancheng,
China
| | - Peng Wang
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou,
China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou,
China
| | - Fan Xia
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou,
China
| | - Liqing Kang
- School of Chemistry and Molecular Engineering, East China Normal University, Shanghai,
China
- Shanghai Unicar-Therapy Bio-medicine Technology Co., Ltd., Shanghai,
China
| | - Lei Yu
- School of Chemistry and Molecular Engineering, East China Normal University, Shanghai,
China
- Shanghai Unicar-Therapy Bio-medicine Technology Co., Ltd., Shanghai,
China
| | - Depei Wu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou,
China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou,
China
| | - Zhengming Jin
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou,
China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou,
China
| | - Changju Qu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou,
China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou,
China
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MIZUTA R, OTANI Y, FUJII K, UNEDA A, ISHIDA J, TANAKA T, IKEGAWA S, FUJII N, MAEDA Y, DATE I. A Case of Relapsed Primary Central Nervous System Lymphoma Treated with CD19-directed Chimeric Antigen Receptor T Cell Therapy. NMC Case Rep J 2022; 9:275-280. [PMID: 36238605 PMCID: PMC9512489 DOI: 10.2176/jns-nmc.2022-0134] [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: 05/05/2022] [Accepted: 06/13/2022] [Indexed: 11/20/2022] Open
Abstract
Although high-dose methotrexate (HD-MTX) is the standard therapy for primary central nervous system lymphoma (PCNSL), the prognosis remains poor. Because 90% of PCNSL is diffuse large B-cell lymphoma (DLBCL), chimeric antigen receptor (CAR)-T cell therapy is expected to be beneficial. However, there are limited reports on CAR-T cell therapy for PCNSL because of the concern of neurotoxicity. Here, we report a case of relapsed PCNSL treated with anti-CD19 CAR-T cell therapy. A 40-year-old woman presenting with visual disturbance in her left eye was initially diagnosed with bilateral uveitis. Her histological diagnosis was DLBCL, and she was positive for CD19. Although she received chemotherapy including HD-MTX, the tumor relapsed in her right occipital lobe. She underwent remission induction therapy and then anti-CD19 CAR-T cell therapy. Cytokine release syndrome (CRS) grade 2 occurred, but there were no complications of CAR-T cell-related encephalopathy syndrome (CRES). She has achieved complete response for more than 1 year. Anti-CD19 CAR-T cell therapy is a revolutionary immunotherapy for treating relapsed or refractory (R/R) B lineage malignancies. Although there are concerns regarding CRS and CRES in central nervous system lymphoma, the use of anti-CD19 CAR-T cells to treat R/R PCNSL is safe and feasible.
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Affiliation(s)
- Ryo MIZUTA
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Yoshihiro OTANI
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Kentaro FUJII
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Atsuhito UNEDA
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Joji ISHIDA
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takehiro TANAKA
- Department of Pathology, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Shuntaro IKEGAWA
- Department of Hematology and Oncology, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Nobuharu FUJII
- Department of Hematology and Oncology, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Yoshinobu MAEDA
- Department of Hematology and Oncology, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Isao DATE
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
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Treatment Options for Recurrent Primary CNS Lymphoma. Curr Treat Options Oncol 2022; 23:1548-1565. [PMID: 36205806 DOI: 10.1007/s11864-022-01016-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 01/30/2023]
Abstract
OPINION STATEMENT Primary CNS lymphoma (PCNSL) constitutes a rare extranodal variant of non-Hodgkin lymphoma (NHL) with an annual incidence of 0.45/100,000. Given the paucity of large prospective clinical trials, there is no consensus treatment for refractory or relapsed (r/r) PCNSL, and available strategies are largely based on retrospective analyses. Patient age, performance status, previously administered treatment, duration of response, and molecular characteristics guide selection of salvage therapy. Patients with a good performance status (KPS >70), particularly ≤65 years, and adequate organ function should be considered for salvage polychemotherapy. Based on its high overall response rate even in the relapsed setting, we choose high-dose (≥ 3.5g/m2) methotrexate (HD-MTX) based regimens, e.g., R-MPV (rituximab, HD-MTX, procarbazine, and vincristine), for remission re-induction as long as patients were sensitive to first line HD-MTX-based regimens, especially when duration of previous response was ≥ 1 year. Following successful remission induction, we choose myeloablative chemotherapy (e.g., thiotepa, busulfan, cyclophosphamide) and subsequent autologous stem cell transplant in curative intent whenever feasible. Alternatively, conventional chemotherapy regimens (for example, monthly HD-MTX) or low-dose whole-brain radiation therapy (WBRT) are selected for consolidation in non-transplant candidates in complete remission. In cases of HD-MTX refractory disease or contraindications, we use pemetrexed; temozolomide/rituximab; high-dose cytarabine; or whole brain radiation for remission induction. Clinical trial participation is considered as well. Emerging therapies for upfront or salvage therapy under ongoing investigation include bruton tyrosine kinase inhibition (e.g., ibrutinib), immunomodulatory drugs (e.g., lenalidomide), immune checkpoint inhibitors (ICI, e.g., nivolumab), and chimeric antigen receptor T (CAR-T) cell therapy.
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Systemic Relapse in a Young Adult Patient with Primary CNS Diffuse Large B-Cell Lymphoma. Case Rep Hematol 2022; 2022:7139661. [PMID: 35774056 PMCID: PMC9239761 DOI: 10.1155/2022/7139661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/06/2022] [Indexed: 12/11/2022] Open
Abstract
Primary central nervous system diffuse large B-cell lymphoma (PCNS-DLBCL) is a rare form of non-Hodgkin's lymphoma, characterized by an aggressive disease course. While CNS relapse is common, systemic relapse is rare with no consensus on optimal treatment. This paper presents an unusual case of advanced PCNS-DLBCL with systemic relapse, including adrenal gland involvement. A review of the existing literature and a discussion on the management of systemic relapse in PCNS-DLBCL is also provided.
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Karschnia P, Rejeski K, Winkelmann M, Schöberl F, Bücklein VL, Blumenberg V, Schmidt C, Blobner J, von Bergwelt-Baildon M, Tonn JC, Kunz WG, Subklewe M, von Baumgarten L. Toxicities and Response Rates of Secondary CNS Lymphoma After Adoptive Immunotherapy With CD19-Directed Chimeric Antigen Receptor T Cells. Neurology 2022; 98:884-889. [PMID: 35351785 PMCID: PMC9169944 DOI: 10.1212/wnl.0000000000200608] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/11/2022] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives Secondary CNS involvement in systemic B-cell lymphoma (SCNSL) is difficult to treat and displays dismal clinical outcomes. Chimeric antigen receptor (CAR) T cells emerged as a powerful treatment for systemic lymphoma. We aimed to evaluate whether CAR T cells also represent a safe and effective therapy for SCNSL. Methods We retrospectively searched our institutional database for patients with SCNSL treated with CD19-directed CAR T cells. Results We identified 10 cases, including 7 patients with intraparenchymal lesions and 3 patients with leptomeningeal disease. CNS staging at 1 month after CAR T-cell transfusion showed disease response (stable disease, partial response, and complete response) in 7 patients (70%), including 2 cases of long-lasting complete response (20%). One patient developed pseudoprogression, which resolved under steroids. Response of CNS disease was associated with systemic 1-month response. With a median follow-up of 6 months, median overall and systemic progression-free survival was 7 and 3 months, respectively. Neurotoxic symptoms occurred in 6 patients, with 3 patients developing severe neurotoxicity (American Society for Transplantation and Cellular Therapy grade ≥3). Discussion CAR T cells induce considerable antitumor effects in SCNSL, and CNS response reflects systemic response. Neurotoxicity appears similar to previous reports on patients with lymphoma without CNS involvement. CAR T cells may therefore represent an effective and safe therapy for SCNSL.
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Affiliation(s)
- Philipp Karschnia
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
| | - Kai Rejeski
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
| | - Michael Winkelmann
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
| | - Florian Schöberl
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
| | - Veit L Bücklein
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
| | - Viktoria Blumenberg
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
| | - Christian Schmidt
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
| | - Jens Blobner
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
| | - Michael von Bergwelt-Baildon
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
| | - Joerg-Christian Tonn
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
| | - Wolfgang G Kunz
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
| | - Marion Subklewe
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
| | - Louisa von Baumgarten
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
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11
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CAR T-cell therapy in primary central nervous system lymphoma: the clinical experience of the French LOC network. Blood 2022; 139:792-796. [PMID: 34871363 PMCID: PMC8814680 DOI: 10.1182/blood.2021012932] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/02/2021] [Indexed: 02/05/2023] Open
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12
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Chan L, Karimi N, Morovati S, Alizadeh K, Kakish JE, Vanderkamp S, Fazel F, Napoleoni C, Alizadeh K, Mehrani Y, Minott JA, Bridle BW, Karimi K. The Roles of Neutrophils in Cytokine Storms. Viruses 2021; 13:v13112318. [PMID: 34835125 PMCID: PMC8624379 DOI: 10.3390/v13112318] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 12/16/2022] Open
Abstract
A cytokine storm is an abnormal discharge of soluble mediators following an inappropriate inflammatory response that leads to immunopathological events. Cytokine storms can occur after severe infections as well as in non-infectious situations where inflammatory cytokine responses are initiated, then exaggerated, but fail to return to homeostasis. Neutrophils, macrophages, mast cells, and natural killer cells are among the innate leukocytes that contribute to the pathogenesis of cytokine storms. Neutrophils participate as mediators of inflammation and have roles in promoting homeostatic conditions following pathological inflammation. This review highlights the advances in understanding the mechanisms governing neutrophilic inflammation against viral and bacterial pathogens, in cancers, and in autoimmune diseases, and how neutrophils could influence the development of cytokine storm syndromes. Evidence for the destructive potential of neutrophils in their capacity to contribute to the onset of cytokine storm syndromes is presented across a multitude of clinical scenarios. Further, a variety of potential therapeutic strategies that target neutrophils are discussed in the context of suppressing multiple inflammatory conditions.
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Affiliation(s)
- Lily Chan
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada; (L.C.); (J.E.K.); (S.V.); (F.F.); (C.N.); (Y.M.); (J.A.M.)
| | - Negar Karimi
- Department of Clinical Sciences, School of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad 91779-4897, Iran;
| | - Solmaz Morovati
- Division of Biotechnology, Department of Pathobiology, School of Veterinary Medicine, Shiraz University, Shiraz 71557-13876, Iran;
| | - Kasra Alizadeh
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Julia E. Kakish
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada; (L.C.); (J.E.K.); (S.V.); (F.F.); (C.N.); (Y.M.); (J.A.M.)
| | - Sierra Vanderkamp
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada; (L.C.); (J.E.K.); (S.V.); (F.F.); (C.N.); (Y.M.); (J.A.M.)
| | - Fatemeh Fazel
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada; (L.C.); (J.E.K.); (S.V.); (F.F.); (C.N.); (Y.M.); (J.A.M.)
| | - Christina Napoleoni
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada; (L.C.); (J.E.K.); (S.V.); (F.F.); (C.N.); (Y.M.); (J.A.M.)
| | - Kimia Alizadeh
- Department of Diagnostic Medicine & Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506, USA;
| | - Yeganeh Mehrani
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada; (L.C.); (J.E.K.); (S.V.); (F.F.); (C.N.); (Y.M.); (J.A.M.)
- Department of Clinical Sciences, School of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad 91779-4897, Iran;
| | - Jessica A. Minott
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada; (L.C.); (J.E.K.); (S.V.); (F.F.); (C.N.); (Y.M.); (J.A.M.)
| | - Byram W. Bridle
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada; (L.C.); (J.E.K.); (S.V.); (F.F.); (C.N.); (Y.M.); (J.A.M.)
- Correspondence: (B.W.B.); (K.K.); Tel.: +1-519-824-4120 (ext. 54657) (B.W.B.); +1-519-824-4120 (ext. 54668) (K.K.)
| | - Khalil Karimi
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada; (L.C.); (J.E.K.); (S.V.); (F.F.); (C.N.); (Y.M.); (J.A.M.)
- Correspondence: (B.W.B.); (K.K.); Tel.: +1-519-824-4120 (ext. 54657) (B.W.B.); +1-519-824-4120 (ext. 54668) (K.K.)
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13
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Chung H, Jung H, Noh JY. Emerging Approaches for Solid Tumor Treatment Using CAR-T Cell Therapy. Int J Mol Sci 2021; 22:ijms222212126. [PMID: 34830003 PMCID: PMC8621681 DOI: 10.3390/ijms222212126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 10/08/2021] [Accepted: 11/08/2021] [Indexed: 12/11/2022] Open
Abstract
Cancer immunotherapy is becoming more important in the clinical setting, especially for cancers resistant to conventional chemotherapy, including targeted therapy. Chimeric antigen receptor (CAR)-T cell therapy, which uses patient’s autologous T cells, combined with engineered T cell receptors, has shown remarkable results, with five US Food and Drug Administration (FDA) approvals to date. CAR-T cells have been very effective in hematologic malignancies, such as diffuse large B cell lymphoma (DLBCL), B cell acute lymphoblastic leukemia (B-ALL), and multiple myeloma (MM); however, its effectiveness in treating solid tumors has not been evaluated clearly. Therefore, many studies and clinical investigations are emerging to improve the CAR-T cell efficacy in solid tumors. The novel therapeutic approaches include modifying CARs in multiple ways or developing a combination therapy with immune checkpoint inhibitors and chemotherapies. In this review, we focus on the challenges and recent advancements in CAR-T cell therapy for solid tumors.
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Affiliation(s)
- Hyunmin Chung
- Immunotherapy Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), 125 Gwahak-ro, Daejeon 34141, Korea;
- College of Pharmacy, Chungnam National University, Yuseong-gu, Daejeon 34134, Korea
| | - Haiyoung Jung
- Immunotherapy Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), 125 Gwahak-ro, Daejeon 34141, Korea;
- Department of Functional Genomics, Korea University of Science and Technology (UST), 113 Gwahak-ro, Yuseong-gu, Daejeon 34113, Korea
- Correspondence: (H.J.); (J.-Y.N.)
| | - Ji-Yoon Noh
- Immunotherapy Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), 125 Gwahak-ro, Daejeon 34141, Korea;
- Correspondence: (H.J.); (J.-Y.N.)
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Alcantara M, Fuentealba J, Soussain C. Emerging Landscape of Immunotherapy for Primary Central Nervous System Lymphoma. Cancers (Basel) 2021; 13:cancers13205061. [PMID: 34680209 PMCID: PMC8534133 DOI: 10.3390/cancers13205061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Primary central nervous system lymphoma (PCNSL) is characterized by its location in the central nervous system comprising the brain, the eye, the cerebrospinal fluid and the spinal cord and a poor prognosis with the current chemotherapies. Immunotherapies represent a new paradigm in the care of patients with B-cell lymphoma, but, till recently, immunotherapies studies excluded patients with PCNSL because of the lack of knowledge on the immune network in the brain. Recent studies shed a new light on the origin and characteristics of the CNS immune cells. We review the current experimental preclinical and clinical developments of immunotherapies in CNS lymphoma as well as the effects of targeted therapies on the brain microenvironment. We provide perspectives for improving the efficacy of immunotherapies in the specific setting of PCNSL for a better prognosis of this disease. Abstract Primary central nervous system lymphoma (PCNSL) is, mainly, a diffuse large B-cell lymphoma (DLBCL) with a non-germinal center B-cell (non-GCB) origin. It is associated with a poor prognosis and an unmet medical need. Immunotherapy has emerged as one of the most promising areas of research and is now part of the standard treatment for many solid and hematologic tumors. This new class of therapy generated great enthusiasm for the treatment of relapsed/refractory PCNSL. Here, we discuss the challenges of immunotherapy for PCNSL represented by the lymphoma cell itself and the specific immune brain microenvironment. We review the current clinical development from the anti-CD20 monoclonal antibody to CAR-T cells, as well as immune checkpoint inhibitors and targeted therapies with off-tumor effects on the brain microenvironment. Perspectives for improving the efficacy of immunotherapies and optimizing their therapeutic role in PCNSL are suggested.
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Affiliation(s)
- Marion Alcantara
- Center for Cancer Immunotherapy, Institut Curie, PSL Research University, INSERM U932, 75005 Paris, France; (M.A.); (J.F.)
- Clinical Hematology Unit, Institut Curie, 92210 Saint-Cloud, France
| | - Jaime Fuentealba
- Center for Cancer Immunotherapy, Institut Curie, PSL Research University, INSERM U932, 75005 Paris, France; (M.A.); (J.F.)
| | - Carole Soussain
- Center for Cancer Immunotherapy, Institut Curie, PSL Research University, INSERM U932, 75005 Paris, France; (M.A.); (J.F.)
- Clinical Hematology Unit, Institut Curie, 92210 Saint-Cloud, France
- Correspondence:
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