大 B 细胞淋巴瘤 CD19-CAR-T 治疗失败后首次治疗的结局

Persistence or recurrence of large B-cell lymphoma after CD19-CAR-T is common, yet data guiding management are limited.

We describe outcomes and features following CAR-T treatment failure. Of 305 adults who received CD19-CAR-T, 182 experienced disease recurrence or progression (1-year cumulative incidence 63% [95%CI: 57-69]). Of 52 post-CAR-T biopsies evaluated by flow cytometry, 49 (94%) expressed CD19. Subsequent anti-cancer treatment was administered in 135/182 (74%) patients with CAR-T treatment failure. Median OS from the first post-CAR-T treatment was 8 months (95%CI 5. 6-11. 0). Polatuzumab-, standard chemotherapy-, and lenalidomide-based treatments were the most common approaches after CAR-T.

No complete responses (CRs) were observed with conventional chemotherapy, while CR rates exceeding 30% were seen following polatuzumab- or lenalidomide-based therapies. Factors associated with poor OS among patients treated post-CAR-T were pre-CAR-T bulky disease (HR 2. 27 [1. 10-4. 72]), lack of response to CAR-T (2. 33 [1. 02-5. 29]), age >65 years (HR 2. 65 [1.

49-4. 73]) and elevated LDH at post-CAR-T treatment (HR 2. 95 [1. 61-5. 38]). The presence of 2 of these factors was associated with inferior OS compared to 1 (56% vs. 19%). In this largest analysis to date of patients who progressed or relapsed after CD19-CAR-T, survival is poor, though novel agents such as polatuzumab and lenalidomide may have hold promise.