大 B 细胞淋巴瘤患者接受靶向 CD19 的 CAR-T 细胞治疗前桥接治疗的影响

In the relapsed/refractory setting for treatment of large B-cell lymphoma (LBCL), chimeric antigen receptor T-cell (CAR-T) therapy has emerged as an effective treatment modality. Patients often have aggressive disease that requires prompt treatment in the form of bridging therapy (BT) for disease stabilisation while CAR-T cells are manufactured. Patients (n = 75) undergoing CAR-T therapy infusion for LBCL at our institution were identified. A total of 52 (69 3%) received BT and 23 (30 7%) received no BT (NBT). BT modalities included systemic BT (SBT) in 28 patients, radiation BT (RBT) in 14, and high-dose steroid BT (HDS) in 10.

There was no difference in incidence of cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome between BT and NBT (P = 0 18 and P = 0 53 respectively). Prolonged cytopenias at Day 180 were more common in BT than NBT (50% vs. 13 3%, P = 0 04).

The SBT and RBT subgroups had more cytopenias at Day 180 compared to the HDS and NBT subgroups (58 3% and 57 1% vs. 20% and 13 3% respectively, P = 0 04). Disease response at last follow-up, progression-free survival and overall survival were similar between BT, NBT, and BT subgroups. In summary, BT can be safely considered in patients undergoing CAR-T therapy.

However, those undergoing BT with SBT or RBT are at higher risk of prolonged cytopenias after CAR-T therapy.