抗 CD19 CAR-T 细胞治疗失败后侵袭性 B 细胞淋巴瘤患者的结局：一项 DESCAR-T 分析

Anti-CD19 chimeric antigen receptor (CAR) T-cells represent a major advance in the treatment of relapsed/refractory aggressive B-cell lymphomas.

However, a significant number of patients experience failure. Among 550 patients registered in the French registry DESCAR-T, 238 (43. 3%) experienced progression/relapse, with a median follow-up of 7. 9 months. At registration, 57. 0% of patients presented an age-adjusted International Prognostic Index of 2 to 3, 18. 9% had Eastern Cooperative Oncology Group performance status 2, 57. 1% received >3 lines of treatment prior to receiving CAR T-cells, and 87. 8% received bridging therapy. At infusion, 66% of patients presented progressive disease, and 38. 9% had high lactate dehydrogenase (LDH). Failure after CAR T-cell treatment occurred after a median of 2.

7 months (range: 0. 2-21. 5). Fifty-four patients (22. 7%) presented very early failure (day [D] 0-D30); 102 (42. 9%) had early failure (D31-D90), and 82 (34. 5%) had late (>D90) failure. After failure, 154 patients (64%) received salvage treatment: 38. 3% received lenalidomide, 7. 1% bispecific antibodies, 21.

4% targeted treatment, 11% radiotherapy, and 20% immunochemotherapy with various regimens. Median progression-free survival was 2. 8 months, and median overall survival (OS) was 5. 2 months. Median OS for patients failing during D0-D30 vs after D30 was 1. 7 vs 3. 0 months, respectively (P = . 0001).

Overall, 47. 9% of patients were alive at 6 months, but only 18. 9% were alive after very early failure. In multivariate analysis, predictors of OS were high LDH at infusion, time to CAR-T failure <D30, and high C-reactive protein at infusion. This multicentric analysis confirms the poor outcome of patients relapsing after CAR T-cell treatment, highlighting the need for further strategies dedicated to this population.