确定淋巴瘤患者在接受 CAR-T 治疗时白细胞分离术中最佳绝对淋巴细胞计数

T-cell fitness can be impaired in patients with large B-cell lymphoma (LBCL) planned for CART (chimeric antigen receptor T-cell therapy). Although absolute lymphocyte count (ALC) at the time of leukapheresis has been shown to associate with outcomes in patients with LBCL treated axicabtagene ciloleucel (axi-cel), no threshold has been identified. This is a multicenter retrospective study including 1 axi-cel training and validation cohort, and 1 mixed-product validation cohort. The change-point method was used to identify an ALC threshold associating with optimal progression-free survival (PFS). Three hundred seventy-nine patients were included in the axi-cel training cohort. ALC as a continuous variable was associated with complete response on day 30 (median, 0. 79 × 10 3 /μL vs 0. 63 × 10 3 /μL; P = . 004). An ALC of 0.

34 × 10 3 /μL was identified as the optimal threshold for PFS (7 vs 3 months; P = . 0013). The association was confirmed in the axi-cel validation cohort (165 patients; 19. 8 vs 3. 5 months; P = . 04) but not in the mixed validation cohort (163 patients; 5 vs 1. 5 months; P = . 3). On univariate analysis, characteristics associated with ALC above the threshold included low International Prognostic Index score ( P = .

02), low serum C-reactive protein level ( P = . 02), low serum ferritin level ( P < . 001), and low number of prior lines of systemic therapy ( P = . 02). An ALC of >0. 34 × 10 3 /μL at the time of apheresis is associated with optimal outcomes in patients with LBCL treated with axi-cel. A deeper investigation of the impact of prior therapies on the number and phenotype of lymphocytes at time of apheresis is warranted.