CNS 桥接放疗在侵袭性 B 细胞淋巴瘤 CAR-T 细胞治疗前实现快速减瘤

Chimeric antigen receptor (CAR) T-cell therapy (CART) for central nervous system lymphoma (CNSL) is a promising strategy, yet responses are frequently not durable. Bridging radiotherapy (BRT) is used for extracranial lymphoma in which it can improve CART outcomes through cytoreduction of high-risk lesions.

We hypothesized that BRT would achieve similar, significant cytoreduction before CART for CNSL (CNS-BRT).

We identified patients with CNSL with non-Hodgkin B-cell lymphoma who received CNS-BRT before commercial CART. Cytoreduction from CNS-BRT was calculated as change in lesion size before CART. Twelve patients received CNS-BRT, and the median follow-up among survivors is 11. 8 months (interquartile range, 8. 5-21. 9). Ten patients had CNSL (9 secondary, 1 primary) and 2 patients had epidural disease (evaluable for toxicity). All 10 patients with CNSL had progressive disease at the time of CNS-BRT. Of 12 patients, 1 experienced grade 3 cytokine release syndrome, and 3 of 12 patients experienced grade 3 immune effector cell-associated neurotoxicity syndrome.

CNS-BRT achieved a 74. 0% (95% confidence interval, 62. 0-86. 0) mean reduction in lesion size from baseline (P = . 014) at a median of 12 days from BRT completion and before CART infusion. Best CNS response included 8 complete responses, 1 partial response, and 1 progressive disease. Three patients experienced CNS relapse outside the BRT field. Preliminary data suggest CNS-BRT achieves rapid cytoreduction and is associated with a favorable CNS response and safety profile. These data support further study of BRT as a bridging modality for CNSL CART.