Outcomes of patients with secondary central nervous system lymphoma following CAR T-cell therapy: a multicenter cohort study. J Hematol Oncol 2023 Nov 09;16(1):111
Date
11/10/2023Pubmed ID
37946255Pubmed Central ID
PMC10633964DOI
10.1186/s13045-023-01508-3Scopus ID
2-s2.0-85176094636 (requires institutional sign-in at Scopus site) 16 CitationsAbstract
Chimeric antigen receptor T-cell therapy (CAR-T) has been successful in treating relapsed/refractory B-cell lymphomas. However, its role in the treatment of diseases involving the central nervous system (CNS) is not well studied. We performed a multicenter retrospective cohort study to evaluate the outcomes of patients with secondary CNS lymphoma (SCNSL) who received CAR-T. Eligibility required active CNSL at the time of apheresis. The objectives included evaluation of overall survival (OS), progression-free survival (PFS), identification of predictors of complete response (CR) post-CAR-T, and assessment of risk factors for cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Sixty-one patients were included in the analysis. The overall response rate was 68% with a CR rate of 57%. In the multivariable analysis, patients who experienced any grade CRS had higher odds of achieving CR (OR = 3.9, 95% CI = 1.01-15.39, p = 0.047). The median PFS was 3.3 months (95% CI = 2.6-6.0 months) with 6- and 12-month PFS rates of 35% and 16%, respectively. The median OS was 7.6 months (95% CI = 5.0-13.5 months) with 6- and 12-month OS rates of 59% and 41%, respectively. Any grade CRS and ICANS were 70% (n = 43) and 57% (n = 34), respectively with grade ≥ 3 CRS and ICANS rates of 16% and 44%. Factors associated with increased risk of CRS and ICANS included receiving axi-cel or having leptomeningeal ± parenchymal + CNS involvement, respectively. Despite achieving high response rates, most patients experience early relapse or death following CAR-T in SCNSL. The current study provides a benchmark for future trials exploring novel therapeutic options in SCNSL.
Author List
Epperla N, Feng L, Shah NN, Fitzgerald L, Shah H, Stephens DM, Lee CJ, Ollila T, Shouse G, Danilov AV, David KA, Torka P, Hashmi H, Hess B, Barta SK, Romancik JT, Cohen JB, Annunzio K, Kittai AS, Reneau J, Zurko J, Nizamuddin IA, Winter JN, Gordon LI, Ma S, Patel R, Nastoupil L, Ahmed S, Karmali RAuthors
Kaitlin Annunzio DO Assistant Professor in the Medicine department at Medical College of WisconsinNirav N. Shah MD Associate Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Antigens, CD19Central Nervous System
Central Nervous System Neoplasms
Humans
Immunotherapy, Adoptive
Lymphoma
Lymphoma, Large B-Cell, Diffuse
Neoplasms, Second Primary
Retrospective Studies