CD19 CAR-T 细胞治疗原发性纵隔大 B 细胞淋巴瘤：一项 CIBMTR 分析

T cells engineered with CD19-directed chimeric antigen receptors (CD19 CAR) T cells have become standard treatment for patients with high risk, relapsed or refractory (R/R) large B-cell lymphomas (LBCL).

However, outcomes in patients with rare subsets of LBCL, such as primary mediastinal large B-cell lymphoma (PBMCL), have not been well characterized. The impact of prior immune checkpoint inhibitor (ICI) treatment, commonly used to treat R/R PMBCL, is also unknown. To address these gaps, we retrospectively analyzed CIBMTR registry data including PMBCL patients undergoing CD19 CAR T-cell therapy per standard-of-care. A total of 135 PMBCL adults from 66 centers were included. Median age at the time of CAR T-cell therapy was 32.

Thirty-nine patients (28. 9%) had received an ICI prior to CAR T-cell therapy. The best overall and complete response (CR) rates after CD19 CAR T-cell therapy were 79% and 67. 7%, respectively. The 2-year progression-free (PFS) and overall survival (OS) were 58. 6% (95% CI, 49. 7-67. 3) and 80. 8% (95% CI, 72. 6-87. 8), respectively. The 2-year cumulative incidence (CI) of relapse and non-relapse mortality (NRM) were 36% (95% CI, 27. 8-44. 7) and 5. 4% (95% CI, 1. 9-10. 5), respectively.

We observed grade 3 CRS and ICANS in 6. 1% and 14. 7%, respectively. Prior ICI exposure was associated with lower 2-year CI of relapse (ICI-exposed, 21. 7%; ICI-na ve, 41. 6%; p = 0. 03) and higher 2-year NRM (ICI-exposed, 11. 7%; ICI-na ve, 2. 8%; p = 0. 03).

We could not confirm statistically different PFS (p = 0. 19) or OS (p = 0. 26) between ICI-exposed and ICI-na ve patients. CD19 CAR T-cell therapy led to high rates of durable responses in PMBCL patients with low rates of severe toxicities.