符合三线 CD19 CAR-T 细胞治疗条件的双重难治大 B 细胞淋巴瘤生存更差

Outcomes following CD19 chimeric antigen receptor (CAR) T-cell therapy in third-line treatment and beyond for patients with large B-cell lymphoma (LBCL) refractory to both an anthracycline during initial and platinum-based salvage therapy, referred to as double refractory (DR), are not well-described. It is also unclear if these patients may be less likely to proceed to CAR T-cell infusion.

Our objectives were to assess third-line CAR T-cell survival outcomes in DR- and non-DR (NDR)-LBCL cohorts including the failure rates to proceed to cell infusion. Review of 199 patients with LBCL referred for CAR T-cell treatment at our center, demonstrates that the DR-LBCL patients (n = 68) have an inferior 12-month (overall survival [OS], 47. 1% vs 66. 7%, respectively;) when compared to the patients with NDR-LBCL (n = 131).

This OS difference is driven by a higher failure rate to proceed to CAR T-cell infusion (32% vs 18%). For patients unable to proceed to CAR T-cell infusion median OS was 2. 56 months; DR-LBCL 1. 94 months vs NDR-LBCL 3. 42 months. The 12-month OS (65% vs 72. 3%) and 6-month progression-free survival (46. 5% vs 57. 2%) of patients with DR- and NDR-LBCL proceeding to CAR T-cell infusion, appears similar.

Our study highlights a high-risk subgroup characterized by inferior OS with challenges in getting to CAR T-cell infusion and could benefit from different management approaches such as novel bridging or "off-the-shelf" strategies.