多中心真实世界评估 Post-CAR 预后指数在 CAR-T 治疗失败后大 B 细胞淋巴瘤患者中的应用

Most patients with large B-cell lymphoma (LBCL) progressing after CAR-T therapy experience poor survival and lack standardized treatment strategies. Prognostic tools are needed to guide decision-making at relapse. The Post-CAR Prognostic Index (PC-PI), recently proposed by Iacoboni et al. , combines five routine clinical variables to stratify outcomes after CAR-T failure: ECOG (> 0), hemoglobin (< 10 g/dL), LDH ( 2xULN), number of extranodal sites (> 1) and time from CAR-T to progression (< 4 months).

We evaluated the PC-PI in a retrospective multicenter study including 125 LBCL patients relapsing or refractory after axicabtagene-ciloleucel or tisagenlecleucel, treated between 2019 and 2023 across 16 Italian centers belonging to the Fondazione Italiana Linfomi network. Median overall survival (OS) was 4. 9 months, with 6- and 12-month OS rates of 44. 9% and 28. 5%, respectively. The PC-PI discriminated prognosis effectively: high-risk patients had a median OS of 1.

8 months, intermediate-high 2. 2, intermediate-low 8. 7, while in the low-risk group median OS was not reached (p<0. 0001). Results remained consistent after excluding patients receiving only palliative care. Post-progression therapy markedly influenced survival: patients receiving active treatment achieved a median OS of 7. 3 months versus 0. 7 without further therapy (p<0. 0001). Bispecific antibodies conferred the best outcomes (HR 0. 44, p=0. 02), with 6- and 12-month OS rates of 90% and 55%.

Our findings confirm the prognostic value of the PC-PI and support its use in clinical practice as a tool for risk-adapted management of LBCL after CAR-T failure.