Faculty Collaboration Database

Impact of extranodal involvement at CAR T-cell therapy on outcomes in patients with relapsed or refractory large B-cell lymphoma-Results from a multicenter cohort study. Blood Cancer J 2025 Jun 21;15(1):110

Date

06/22/2025

Pubmed ID

40544154

Pubmed Central ID

PMC12182562

DOI

10.1038/s41408-025-01318-5

Scopus ID

2-s2.0-105008531660 (requires institutional sign-in at Scopus site)   7 Citations

Abstract

Extranodal (EN) diffuse large B-cell lymphoma (DLBCL) has been historically associated with inferior survival outcomes compared to nodal DLBCL. However, outcomes of patients with EN DLBCL following chimeric antigen receptor T-cell (CAR-T) therapy are not well established. In this multi-center retrospective cohort study, we evaluated the outcomes of patients with EN DLBCL who underwent CAR-T in the relapsed/refractory (R/R) setting. The primary objective was overall survival (OS), while secondary objectives included progression-free survival (PFS), response rates, and toxicity rates. A total of 218 patients were included in the analysis. The most common sites of EN involvement were skin/soft tissue (25%), bone (22%), and lung (17%). Overall response rate (ORR) and complete response rate (CRR) at first post-treatment evaluation were 62% (n = 127) and 40% (n = 82), respectively. Median follow-up was 3.5 years. Median PFS and OS were 4.0 months (95% CI = 3.1-7.2) and 25.7 months (95% CI = 16.1-51.6), respectively. Cytokine release syndrome (CRS) of any grade occurred in 73% (n = 159) of patients, and 6% (n = 12) had grade ≥ 3 CRS. Immune effector cell-associated neurotoxicity syndrome (ICANS) of any grade occurred in 37% (n = 81) of patients, and 19% (n = 41) developed grade ≥ 3 ICANS. In the multivariable analysis, factors that were independently prognostic of inferior OS were 3 or more lines of therapy prior to CAR-T, bulky disease at the time of CAR-T, hepatobiliary, and pancreas involvement, while refractory disease to the most recent therapy prior to CAR-T was associated with inferior PFS. Future studies should further evaluate outcomes of CAR-T in patients with specific EN sites of involvement that appear to be associated with inferior survival such as the liver and pancreas.

Author List

St-Pierre F, Bhatta S, Doukas PG, Jenkin M, Annunzio K, Rojek AE, Gibson A, Tiger YK, McCall B, Alhamad K, Hansen A, Alderuccio JP, Adewale O, Patel K, Trabolsi A, Lossos IS, Fitzgerald L, Ollila TA, Matasar MJ, Kline J, Karmali R, Epperla N

Author

Kaitlin Annunzio DO Assistant Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Female
Humans
Immunotherapy, Adoptive
Lymphoma, Large B-Cell, Diffuse
Male
Middle Aged
Retrospective Studies
Treatment Outcome
Young Adult