No abstract

Axicabtagene ciloleucel (axi-cel) is a chimeric antigen receptor (CAR) T cell therapy for relapsed or refractory large B cell lymphoma (LBCL). Here, we evaluated whether immune dysregulation, present prior to CAR-T cell therapy, associated with treatment failure. Tumor expression of interferon (IFN) signaling, high blood levels of monocytic myeloid-derived suppressor cells (M-MDSCs), and high blood IL-6 and ferritin each associated with a lack of durable response. Similar to other cancers, we found that in LBCL tumor IFN signaling is associated with the expression of multiple checkpoint ligands including PD-L1, and these were higher in patients who lacked durable responses to CAR-T therapy. Moreover, tumor IFN signaling and blood M-MDSCs associated with decreased axi-cel expansion. Finally, patients with high tumor burden had higher immune dysregulation with increased serum inflammatory markers and tumor IFN signaling. These data support that immune dysregulation in LBCL promotes axi-cel resistance via multiple mechanistic programs: insufficient axi-cel expansion associated with both circulating M-MDSC and tumor IFN signaling, that also gives rise to expression of immune checkpoint ligands.

Maximal cytoreductive surgery combined with regional (HIPEC) and systemic chemotherapy in selected patients with gastric carcinomatosis and limited disease burden can achieve prolonged survival.