Don't Put the CART Before the Horse: The Role of Radiation Therapy in Peri-CAR T-cell Therapy for Aggressive B-cell Non-Hodgkin Lymphoma

Saifi, Omran; Breen, William; Lester, Scott C.; Rule, William G.; Stish, Bradley J.; Rosenthal, Allison; Muñoz, Javier; Lin, Yi; Bansal, Radhika; Hathcock, Matthew; Bennani, N. Nora; Paludo, Jonas; Khurana, Arushi; Villasboas, José C.; Johnston, Patrick B.; Ansell, Stephen M.; Iqbal, Madiha; Moustafa, Muhamad Alhaj; Murthy, Hemant S.; Kharfan‐Dabaja, Mohamed A.; Hoppe, B.S.; Peterson, Jennifer

doi:10.1016/j.ijrobp.2022.12.017

Cited by 13 publications

(40 citation statements)

References 18 publications

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“…30 Extensive relapses have worse prognosis compared to limited relapses. [31][32][33][34] Therefore, treatments that cytoreduce/debulk pre-CART disease, consolidate residual post-CART disease, and salvage progressive post-CART disease are desperately needed given the post-CART outcomes.…”

Section: How Durable Is the Cart Response And How Many Patients Relap...mentioning

confidence: 99%

“…These include bulky tumors, Myc with BCL2 and/or BCL6 rearrangements and high MTV. 34,[40][41][42] 3.4 | BRT may prime the immune system and sensitize CART cells RT has the potential to sensitize solid tumors to immunotherapy/ cellular therapy 43,44 as well as provoking an abscopal-like effect to CART. 45,46 This suggests its ability to enhance CART-cell activity.…”

Section: Brt Improves Local Control and May Alter The Pattern Of Rela...mentioning

confidence: 99%

“…or with comprehensive BRT to a dose of EQD2 ≥ 30 Gy. 34 3.5 | BRT is safe and may be effective for pre-CART central nervous system disease…”

Section: Brt Improves Local Control and May Alter The Pattern Of Rela...mentioning

confidence: 99%

“…30 However, limited post-CART relapsed disease has a better prognosis relative to extensive relapsed disease. [32][33][34] This calls for innovative consolidative/salvage strategies as CART utilization continues to grow. RT can serve as a promising consolidative/salvage intervention for selected patients with residual or relapsed post-CART disease.…”

Section: Radiation As a Consolidative And Salvage Intervention For Po...mentioning

confidence: 99%

“…Patients who experience extensive disease relapse post-CART have a poor prognosis. 31,33,34,52 RT at this stage is indicated for palliation of symptoms. RT is very effective in treating and controlling the targeted site of disease.…”

Section: Radiotherapy For Extensive Post-cart Disease Palliates Symptomsmentioning

confidence: 99%

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Incorporating radiation with anti‐CD19 chimeric antigen receptor T‐cell therapy for relapsed/refractory non‐Hodgkin lymphoma: A multicenter consensus approach

Saifi,

Lester,

Breen

et al. 2023

American J Hematol

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Anti‐CD19 chimeric antigen receptor T‐cell therapy (CART) has revolutionized the outcomes of relapsed and/or refractory B‐cell non‐Hodgkin lymphoma. However, CART is still limited by its availability, toxicity, and response durability. Not all patients make it to the CART infusion phase due to disease progression. Among those who receive CART, a significant number of patients experience life‐threatening cytokine release syndrome toxicity, and less than half maintain a durable response with the majority relapsing in pre‐existing sites of disease present pre‐CART. Radiation therapy stands as a promising peri‐CART and salvage treatment that can improve the outcomes of these patients. Evidence suggests that bridging radiotherapy prior to CART controls the disease during the manufacturing period, augments response rates and local control, cytoreduces/debulks the disease and decreases the severity of cytokine release syndrome, and may prolong disease‐free intervals and survival especially in patients with bulky disease. Consolidative radiotherapy for residual post‐CART disease alters the pattern of relapse and improves local recurrence‐free and progression‐free survivals. Salvage radiotherapy for relapsed post‐CART disease has favorable survival outcomes when delivered comprehensively for patients with limited relapsed disease and palliates symptoms for patients with diffuse relapsed disease. The biology of the disease during the peri‐CART period is poorly understood, and further studies investigating the optimal timing and dosing of radiation therapy (RT) are needed. In this review, we tackle the most significant challenges of CART, review and propose how RT can help mitigate these challenges, and provide The Mayo Clinic experts' approach on incorporating RT with CART.

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Section: How Durable Is the Cart Response And How Many Patients Relap...mentioning

confidence: 99%

Section: Brt Improves Local Control and May Alter The Pattern Of Rela...mentioning

confidence: 99%

“…or with comprehensive BRT to a dose of EQD2 ≥ 30 Gy. 34 3.5 | BRT is safe and may be effective for pre-CART central nervous system disease…”

Section: Brt Improves Local Control and May Alter The Pattern Of Rela...mentioning

confidence: 99%

Section: Radiation As a Consolidative And Salvage Intervention For Po...mentioning

confidence: 99%

Section: Radiotherapy For Extensive Post-cart Disease Palliates Symptomsmentioning

confidence: 99%

See 3 more Smart Citations

Incorporating radiation with anti‐CD19 chimeric antigen receptor T‐cell therapy for relapsed/refractory non‐Hodgkin lymphoma: A multicenter consensus approach

Saifi,

Lester,

Breen

et al. 2023

American J Hematol

Self Cite

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Comprehensive Bridging Radiotherapy for Limited Pre-CART Non-Hodgkin Lymphoma

Saifi,

Breen,

Rule

et al. 2024

JAMA Oncol

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Role of Radiation in Combination With CD30-Directed Chimeric Antigen Receptor T-Cell Therapy for Relapsed/Refractory Hodgkin Lymphoma

Ladbury,

Hao,

Mei

et al. 2024

Advances in Radiation Oncology

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Don't Put the CART Before the Horse: The Role of Radiation Therapy in Peri-CAR T-cell Therapy for Aggressive B-cell Non-Hodgkin Lymphoma

Cited by 13 publications

References 18 publications

Incorporating radiation with anti‐CD19 chimeric antigen receptor T‐cell therapy for relapsed/refractory non‐Hodgkin lymphoma: A multicenter consensus approach

Incorporating radiation with anti‐CD19 chimeric antigen receptor T‐cell therapy for relapsed/refractory non‐Hodgkin lymphoma: A multicenter consensus approach

Comprehensive Bridging Radiotherapy for Limited Pre-CART Non-Hodgkin Lymphoma

Role of Radiation in Combination With CD30-Directed Chimeric Antigen Receptor T-Cell Therapy for Relapsed/Refractory Hodgkin Lymphoma

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