Predictive factors of early progression after CAR T-cell therapy in relapsed/refractory diffuse large B-cell lymphoma

Blood Advances - Tập 4 - Trang 5607-5615 - 2020
Laetitia Vercellino1, Roberta Di Blasi2, Salim Kanoun3, Benoit Tessoulin4,5,6, Cedric Rossi7, Maud D'Aveni-Piney8,9, Lucie Obéric10, Caroline Bodet-Milin11, Pierre Bories10, Pierre Olivier12, Ingrid Lafon7, Alina Berriolo-Riedinger13, Eugenio Galli2, Sophie Bernard2, Marie-Thérèse Rubio8,9, Celine Bossard14, Veronique Meignin15, Pascal Merlet1, Pierre Feugier8,16, Steven Le Gouill4
1Department of Nuclear Medicine, Saint-Louis Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France;
2Department of Hemato-Oncology, Saint-Louis Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris, France;
3Department of Nuclear Medicine, Oncolopole, Toulouse, France;
4Centre Hospitalier Universitaire (CHU) Nantes, Service d'Hématologie Clinique, Hôtel-Dieu, Nantes, France;
5INSERM, Centre National de la Recherche Scientifique (CNRS), Centre de Recherche en Cancérologie et Immunologie Nantes Angers (CRCINA), Nantes, France;
6Faculté de Médecine, Université de Nantes, Nantes, France
7Hematology, CHU Dijon, INSERM Unité Mixte de Recherche (UMR) 1231, Dijon, France;
8Department of Hematology, Brabois Hospital, Centre Hospitalier Régional Universitaire (CHRU), Nancy, France;
9CNRS UMR 7563, Biopole de l'Université de Lorraine, Vandoeuvre les Nancy, France;
10Department of Hematology, Oncopole, CHU Toulouse, Toulouse, France;
11Department of Nuclear Medicine, CHU Nantes, Nantes, France
12Department of Nuclear Medicine, CHU Brabois, Nancy, France;
13Department of Nuclear Medicine, Center Georges-François Leclerc, Dijon, France;
14Department of Pathology, CHU Nantes, Nantes, France;
15Department of Pathology, AP-HP, Saint-Louis Hospital, Paris, France;
16INSERM 1256, Université de Lorraine, Nancy, France;

Tóm tắt

Abstract Chimeric antigen receptor (CAR) T-cell therapy has emerged as an option for relapsed/refractory aggressive B-cell lymphomas that have failed 2 lines of therapy. Failures usually occur early after infusion. The purpose of our study was to identify factors that may predict failure, particularly early progression (EP), within the first month after infusion. Characteristics of 116 patients were analyzed at the time of decision (TD) to use commercial CAR (axicabtagene ciloleucel, n = 49; tisagenlecleucel n = 67) and at the time of treatment (TT), together with total metabolic tumor volume (TMTV) at TT. With a median follow-up of 8.2 months, 55 patients failed treatment; 27 (49%) were early progressors. The estimated 12-month progression-free survival (PFS) and overall survival (OS) were 47.2% (95% confidence interval [CI], 38.0-58.6) and 67.0% (95% CI, 57-79), respectively. Univariate analyses for PFS and OS identified Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≥2, stage III/IV disease, extranodal (EN) sites ≥2, elevated lactate dehydrogenase (LDH), increased C-reactive protein (CRP), high International Prognostic Index at TD and at TT, as well as increased CRP, bulky mass, and high TMTV at TT, as risk factors. Multivariate analyses for PFS, EP, and OS identified elevated LDH and EN sites ≥2 at TD and the same predictors at TT (ie, increased CRP, EN sites ≥2, and TMTV >80 mL). In summary, risk factors identified for early progression at TD and at TT were EN involvement (≥2 sites) and lymphoma burden (LDH, TMTV).

Tài liệu tham khảo

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Blood Advances

Tập 4

5607-5615

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