CAR-T 挽救治疗后高级别 B 细胞淋巴瘤与其他大 B 细胞淋巴瘤的结局比较：一项 DESCAR-T LYSA 研究

High-grade B-cell lymphoma (HGBL) with MYC and BCL2 and/or BCL6 rearrangements (double hit [HGBL-DH] or triple hit [HGBL-TH]) or not otherwise specified (HGBL-NOS) are considered to be more aggressive diseases among large B-cell lymphomas (LBCLs). CD19-targeting chimeric antigen receptor (CAR) T cells have changed the prognosis of chemoresistant LBCL. Clinical and pathological data of patients treated for relapsed/refractory LBCL or HGBL in third line or more, all characterized by fluorescence in situ hybridization, were collected from the French DESCAR-T registry. Between January 2018 and November 2022, a total of 228 patients were included across 14 centers, 73 with HGBL (28 HGBL-DH MYC-BCL2, 14 HGBL-TH, 8 HGBL-DH MYC-BCL6, and 23 HGBL-NOS) and 155 with non-HGBL.

The median follow-up was 18. 5 months (95% confidence interval [CI], 14. 3-23. 4) from the date of infusion. Progression-free survival and overall survival (OS) were not significantly different between HGBL and non-HGBL, at 3. 2 months (95% CI, 2. 8-6. 0) vs 4. 5 months (95% CI, 3. 1-8. 7; P = . 103) and 15.

4 months (95% CI, 5. 6-32. 4) vs 18. 3 months (95% CI, 8. 5 to not reached), respectively. From the date of eligibility, the median OS was inferior for patients with HGBL-TH/DH MYC-BCL2 at 6. 6 months vs 18. 5 months for HGBL-NOS vs 13. 6 months for HGBL-DH MYC-BCL6 vs 11. 8 months for LBCL (P = . 037).

However, patients who received infusion presented the same outcome. CAR T-cell therapy used in third line or more seems to overcome the poor prognosis of HGBL subtypes, especially in HGBL-TH/DH MYC-BCL2. This observation supports considering the potential benefit of using CAR T cells earlier in disease course.