继发性中枢神经系统淋巴瘤患者接受 CAR-T 细胞治疗后的结局：一项多中心队列研究

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.