Peri-CAR-T practice patterns and survival predictors for all CAR-T patients and post-CAR-T failure in aggressive B-NHL

• Type of Material: Article
• Authors: Joanna Zurko, University of Wisconsin; Imran Nizamuddin, Northwestern University; Narendranath Epperla, Ohio State University; Kevin David, Rutgers University; Jonathon Cohen, Emory University; Tamara K Moyo, Atrium Health Carolinas Medical Center, Charlotte; Thomas Ollila, Brown University; Brian Hess, Medical University of South Carolina; Ishan Roy, Northwestern University; Robert Ferdman, Roswell Park Comprehensive Cancer Center, Buffalo; Jieqi Liu, Rutgers University; Sayan Mullick Chowdhury, Ohio State University; Jason Romancik, Emory University; Rahul S Bhansali, University of Pennsylvania; Elyse I Harris, University of Wisconsin; Mckenzie Sorrell, Medical University of South Carolina; Rebecca Masel, Brown University; Adam S Kittai, Ohio State University; Nathan Denlinger, Ohio State University; Audrey M Sigmund, Ohio State University; Lindsey Fitzgerald, University of Utah; Carlos Galvez, Northwestern University; Shuo Ma, Northwestern University; Jane Winter, Northwestern University; Barbara Pro, Northwestern University; Leo I Gordon, Northwestern University; Alexey Danilov, City of Hope Comprehensive Cancer Center, Duarte; Deborah Stephens, University of Utah; Nirav N Shah, Medical College of Wisconsin, Milwaukee; Vaishalee Kenkre, University of Wisconsin; Stefan K Barta, University of Pennsylvania; Pallawi Torka, Roswell Park Comprehensive Cancer Center, Buffalo; Geoffrey Shouse, City of Hope Comprehensive Cancer Center, Duarte; Reem Karmali, Northwestern University
• Language: English
• Date: 2023-06-16
• Publisher: ELSEVIER
• Publication Version: Final Published Version
• Copyright Statement: © 2023 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1182/bloodadvances.2022008240
• Title of Journal or Parent Work: BLOOD ADVANCES
• Volume: 7
• Issue: 12
• Start Page: 2657
• End Page: 2669
• Keywords: MULTICENTER; MANAGEMENT; CELL THERAPY; Life Sciences & Biomedicine; Hematology; Science & Technology; LENALIDOMIDE; LYMPHOMA; SINGLE-ARM
• Research Categories: Health Sciences, Oncology; Health Sciences, Medicine and Surgery

Abstract

Most patients receiving chimeric antigen receptor T-cell therapy (CAR-T) for aggressive B-cell non-Hodgkin lymphoma (B-NHL) do not experience a durable remission. Several novel agents are approved to treat relapsed, refractory aggressive B-NHL; however, it remains unclear how to sequence these therapies pre– and post–CAR-T. We conducted a multicenter retrospective analysis to describe peri–CAR-T practice patterns and survival predictors for patients receiving CD19-directed CAR-T. Patients (n = 514) from 13 centers treated with CAR-T for B-NHL between 2015-2021 were included in the study. Survival curves were constructed using Kaplan-Meier method. Multivariate Cox regression analysis was used to determine the impact of the variables on survival outcomes. For all patients receiving CAR-T, a greater number of lines of therapy pre-CAR-T apheresis and bridging therapy were predictive of inferior progression-free survival (PFS) and overall survival (OS). The median PFS and OS from the time of CAR-T cell infusion were 7.6 and 25.6 months, respectively. From the time of progression post–CAR-T, the median OS was 5.5 months. The median PFS of treatments administered in the first-line post–CAR-T failure was 2.8 months. Patients with refractory disease on day 30 had inferior OS and were less likely to receive subsequent treatment(s) than other patients with CAR-T failure. Allogeneic hematopoietic cell transplantation for selected patients at any time following CAR-T failure led to durable responses in over half of patients at 1 year. These data provide a benchmark for future clinical trials in patients with post–CAR-T cell progression, which remains an unmet clinical need.