Outcomes of patients with secondary central nervous system lymphoma following CAR T-cell therapy: a multicenter cohort study
Year: 2023
Type: article
Study design: Observational Study
Abstract: 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.
Source: Journal of Hematology & Oncology
Authors: Narendranath Epperla, Lei Feng, Nirav N. Shah, Lindsey Fitzgerald, Harsh Shah, Deborah M. Stephens, Catherine J. Lee, Thomas Ollila, Geoffrey Shouse, Alexey V. Danilov, Kevin A. David, Pallawi Torka, Hamza Hashmi, Brian Hess, Stefan K. Barta, Jason T. Romancik, Jonathon B. Cohen, Kaitlin Annunzio, Adam S. Kittai, John Reneau, Joanna Zurko, Imran A. Nizamuddin, Jane N. Winter, Leo I. Gordon, Shuo Ma, Romil Patel, Loretta Nastoupil, Sairah Ahmed, Reem Karmali
Institutions: The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, The University of Texas MD Anderson Cancer Center, Medical College of Wisconsin, Huntsman Cancer Institute, University of Washington Medical Center, Fred Hutch Cancer Center, Brown University, Lifespan, City Of Hope National Medical Center, Rutgers, The State University of New Jersey, Memorial Sloan Kettering Cancer Center, Rutgers Cancer Institute, Roswell Park Comprehensive Cancer Center, Medical University of South Carolina, MUSC Hollings Cancer Center, Abramson Cancer Center, University of Pennsylvania, Emory University, Winship Cancer Institute, Northwestern University, Robert H. Lurie Comprehensive Cancer Center of Northwestern University
Language: English
Topic: CAR-T cell therapy research
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,390
OpenAlex ID: W4388532299