减少和控制 CAR-T 细胞输注前代谢活性肿瘤体积可改善大 B 细胞淋巴瘤患者的生存结局

Bridging therapy before CD19-directed chimeric antigen receptor (CAR) T-cell infusion is frequently applied in patients with relapsed or refractory Large B-cell lymphoma (r/r LBCL).

This study aimed to assess the influence of quantified MATV and MATV-dynamics, between pre-apheresis (baseline) and pre-lymphodepleting chemotherapy (pre-LD) MATV, on CAR T-cell outcomes and toxicities in patients with r/r LBCL. MATVs were calculated semi-automatically at baseline (n = 74) and pre-LD (n = 68) in patients with r/r LBCL who received axicabtagene ciloleucel.

At baseline, patients with a low MATV (< 190 cc) had a better time to progression (TTP) and overall survival (OS) compared to high MATV patients (p < 0. 001). High MATV patients who remained stable or reduced upon bridging therapy showed a significant improvement in TTP (p = 0. 041) and OS (p = 0. 015), compared to patients with a high pre-LD MATV (> 480 cc).

Furthermore, high MATV baseline was associated with severe cytokine release syndrome (CRS, p = 0. 001).

In conclusion, patients with low baseline MATV had the best TTP/OS and effective reduction or controlling MATV during bridging improved survival outcomes in patients with a high baseline MATV, providing rationale for the use of more aggressive bridging regimens.