靶向 CD19 的 CAR-T 细胞治疗转化型非滤泡性淋巴瘤的结局

CD19-directed chimeric antigen receptor (CAR) T cell (CAR-T) therapy with axicabtagene ciloleucel (axi-cel) or tisagenlecleucel (tisa-cel) are approved for the treatment of relapsed or refractory large B cell lymphoma (LBCL), including de novo diffuse LBCL (DLBCL), primary mediastinal B cell lymphoma (PMBCL), and transformed follicular lymphoma (tFL).

Transformed nonfollicular lymphomas (tNFLs), including transformed marginal zone lymphoma (tMZL) and transformed chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) were not included in their respective pivotal studies.

This study was conducted to evaluate the outcomes of axi-cel and tisa-cel in tNFL patients, including those who received ibrutinib concomitantly through apheresis, lymphodepletion, and CAR-T infusion. This single-center retrospective study included all patients with tCLL/SLL, tMZL, tFL, and DLBCL/PMBCL treated with CAR-T therapy outside of a clinical trial setting from November 2017 to May 2021 at Moffitt Cancer Center, Tampa, Florida.

We analyzed and compared outcomes in patients with tCLL/SLL or tMZL and patients with DLBCL/tFL. The study included 134 patients who received a total of 136 CAR-T treatments (111 with axi-cel and 25 with tisa-cel). Ninety patients had de novo DLBCL/PMBCL, 23 had tFL, and 21 had tNFL (12 with tMZL and 9 with tCLL/SLL). The overall response and complete response rates were 66. 7% and 55. 6%, respectively, for tCLL/SLL and 92. 9% and 71. 4% for tMZL. The overall response and complete response rates were not different between tNFL and DLBCL/tFL (P = . 92 and . 81, respectively). At a median follow-up of 21. 3 months, the median progression-free survival (PFS) for tCLL/SLL was 5. 4 months (95% confidence interval [CI], . 8 month to not assessable [NA]); for tMZL, the median PFS was not reached (NR) (95% CI, 2. 3 months to NA); and for DLBCL/tFL, the median PFS was 14. 3 months (95% CI, 5. 6 months to NA) (P = . 58). The estimated 1-year PFS rate was 29.

6% (95% CI, 5. 2% to 60. 7%) for tCLL/SLL, 50. 0% (95% CI, 22. 9% to 72. 2%) for tMZL, 42. 7% (95% CI, 22. 4% to 61. 6%) for tNFL, and 53. 0% (95% CI, 42. 3% to 62. 5%) for DLBCL/tFL. The median overall survival was NR (95% CI, 9. 2 months to NA) for tCLL/SLL, 27. 1 months (95% CI, 8. 5 months to NA) for tMZL, and NR (95% CI, 17. 4 months to NA) for DLBCL/tFL (P = . 79). Compared to the DLBCL/tFL cohort, tNFL patients were more likely to develop immune effector cell-associated neurologic syndrome (ICANS) and to receive tocilizumab (P = .

04 and . 01, respectively, after controlling for CAR-T product) and with a possibly higher incidence of grade 3 cytokine release syndrome (CRS) (P = . 07). Two patients in the tNFL cohort died of treatment-related toxicity after receiving axi-cel. Six tNFL patients received ibrutinib concurrently with tisa-cel, with 1 case of grade 3 CRS/ICANS that rapidly resolved and no other severe toxicities.

Our case series supports the use of CD19 CAR-T therapy in relapsed/refractory tCLL/SLL and tMZL. The concurrent use of ibrutinib and tisa-cel in tNFL was associated with manageable toxicity in tNFL.