Does bridging radiation therapy affect the pattern of failure after CAR T-cell therapy in non-Hodgkin lymphoma?

Saifi, Omran; Breen, William; Lester, Scott C.; Rule, William G.; Stish, Bradley J.; Rosenthal, Allison; Muñoz, Javier; Herchko, Steven; Murthy, Hemant S.; Lin, Yi; Bansal, Radhika; Hathcock, Matthew; Bennani, N. Nora; Paludo, Jonas; Wang, Yucai; Khurana, Arushi; Bisneto, Jose C. Villasboas; Johnston, Patrick B.; Ansell, Stephen M.; Iqbal, Madiha; Tun, Han W.; Ayala, Ernesto; Kharfan‐Dabaja, Mohamed A.; Hoppe, B.S.; Peterson, Jennifer

doi:10.1016/j.radonc.2021.11.031

Cited by 37 publications

(56 citation statements)

References 35 publications

(43 reference statements)

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“…Notably, in an analysis by the United States Lymphoma CAR T Consortium, BT was associated with inferior overall survival (OS) on multivariate analysis, although a specific contribution by BT modality was not provided [ 9 ]. Overall, prior institutional experiences with BT have also supported this finding, although patients who received radiation BT appeared to have comparable outcomes to patients who did not receive BT [ 10 , 11 , 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 66%

Long-Term Follow-Up of Bridging Therapies Prior to CAR T-Cell Therapy for Relapsed/Refractory Large B Cell Lymphoma

Ladbury

Dandapani

Hao

et al. 2023

Cancers

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Background: Bridging therapy (BT) with systemic therapy (ST), radiation therapy (RT), or combined-modality therapy (CMT) is increasingly being utilized prior to chimeric antigen receptor (CAR) T-cell therapy for large B-cell lymphoma (LBCL). We report the long-term outcomes of the patients who received commercial CAR T-cell therapy with or without BT. Methods: The patients with LBCL who underwent infusion of a commercial CD19 CAR T product were eligible. The radiation was stratified as comprehensive or focal. The efficacy outcomes and toxicity were analyzed. Results: In total, 156 patients were included and, of them, 52.5% of the patients received BT. The median progression-free survival (PFS) was 0.65 years in the BT cohort compared to 1.45 years in the non-BT cohort. The median overall survival (OS) was 3.16 years in the BT cohort and was not reached in the non-BT cohort. The patients who received comprehensive radiation (versus focal) had significantly improved PFS and OS, achieving a 1-year PFS of 100% vs. 9.1% and 1-year OS of 100% vs. 45.5%. There was no difference in the severe toxicity between any of the nonbridging or BT cohorts. Conclusions: BT did not appear to compromise outcomes with respect to response rates, disease control, survival, and toxicity. The patients with limited disease treated with RT had favorable outcomes.

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Section: Introductionmentioning

confidence: 66%

Long-Term Follow-Up of Bridging Therapies Prior to CAR T-Cell Therapy for Relapsed/Refractory Large B Cell Lymphoma

Ladbury

Dandapani

Hao

et al. 2023

Cancers

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“…Eleven of 21 patients (52 %) received SRT to lesions that were present pre-CART therapy. Patterns of failure analyses suggest that most progressions (86 %-88 %) post-CART therapy involve pre-existing lesions [19] , [20] . Figura et al identified pre-CART lesion characteristics that are at high risk for local failure post-CART, including maximum diameter ≥ 5 cm, extranodal component, and max SUV ≥ 10 [20] .…”

Section: Discussionmentioning

confidence: 99%

Salvage radiotherapy for relapsed/refractory non‐Hodgkin lymphoma following CD19 chimeric antigen receptor T-cell (CART) therapy

Yegya-Raman¹,

Wright²,

LaRiviere³

et al. 2023

Clinical and Translational Radiation Oncology

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“…In the ZUMA-12 trial, where axi-cel was used as first-line therapy in high-risk LBCL (DHL/THL or IPI ⩾3), with an interim PET scan showing a Deauville score ⩾4 after two cycles of chemo-immunotherapy, the ORR was 89%, and the CR rate was 78%. 36 With the promising results of ZUMA-12, attractive variables include the possibility of having a better quality of CAR-T cells prior to exposing lymphocytes to multiple lines of chemotherapy, 37 older patients better tolerating CAR-T over auto-HCT, 38 better managing and preventing CAR-T toxicity with corticosteroids or other maneuvers as anakinra, 39 , 40 utilizing more tolerable bridging therapy, 41 and avoiding the risk of secondary malignancy after high-dose chemotherapy with auto-HCT; 42 anti-CD19 CAR-T may be a safe and tolerable option in the first line for high-risk patients, but this possibility will need to be investigated further in the setting of a randomized trial.…”

Section: Discussionmentioning

confidence: 99%

The role of CAR-T cell therapy as second line in diffuse large B-cell lymphoma

Albanyan

Chávez

Muñoz

2022

Therapeutic Advances in Hematology

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For approximately three decades, autologous hematopoietic cell transplantation (auto-HCT) has been the standard of care for patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) after frontline therapy. This approach is limited due to the intensity of chemotherapy and the proportion of patients who relapse after auto-HCT. Since the approval of anti-CD19 chimeric antigen receptor T-cell (CAR-T) therapy and novel agents, the treatment paradigm for DLBCL has changed remarkably. Anti-CD19 CAR-T therapy was first approved for relapsed DLBCL after two or more previous lines of therapy with long-lasting responses, with over 50% of patients still alive at 5-year follow-up. Here, we discuss recent randomized phase 3 clinical trials using axicabtagene ciloleucel, tisagenlecleucel, and lisocabtagene maraleucel in the second-line therapy setting compared with the standard of care in transplant-eligible patients who have DLBCL R/R within 12 months of completing chemo-immunotherapy, potentially changing the treatment algorithm for DLBCL.

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Does bridging radiation therapy affect the pattern of failure after CAR T-cell therapy in non-Hodgkin lymphoma?

Cited by 37 publications

References 35 publications

Long-Term Follow-Up of Bridging Therapies Prior to CAR T-Cell Therapy for Relapsed/Refractory Large B Cell Lymphoma

Long-Term Follow-Up of Bridging Therapies Prior to CAR T-Cell Therapy for Relapsed/Refractory Large B Cell Lymphoma

Salvage radiotherapy for relapsed/refractory non‐Hodgkin lymphoma following CD19 chimeric antigen receptor T-cell (CART) therapy

The role of CAR-T cell therapy as second line in diffuse large B-cell lymphoma

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