Patterns and Predictors of Failure in Recurrent or Refractory Large B-Cell Lymphomas After Chimeric Antigen Receptor T-Cell Therapy

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

“…Our findings are consistent with the recent pattern of CART failure analysis reported by Figura et al who showed that most recurrences had a component of local failure (86%) [12], similar to ours (88%). This marks as the second confirmatory report of local failures being the predominant mode of progression in CART.…”

“…This marks as the second confirmatory report of local failures being the predominant mode of progression in CART. Furthermore, they identified lesions at high risk for local recurrence to include those with a diameter 5 cm, SUV max 10, and extranodal disease [12], which fits our in-field recurrence characteristics. However, they did not report data on bRT and its local control rate and effect on local progressions and pattern of failure [12].…”

“…Bridging treatments can be prescribed during the manufacturing phase with the aim of controlling the disease progression. Indeed, a small number of recent reports have shown a promising role for radiation therapy (RT) as a bridging strategy to CART [10][11][12][13][14]. RT already plays an important role in the treatment of B-cell lymphoma as consolidation in first-line therapy, part of perihematopoietic stem cell transplant (HCT) treatments [15][16][17], for treatment of bulky disease [18,19], and in chemo/HCT-refractory disease [15,16,20,21].…”

Primary refractory primary mediastinal lymphoma treated with CAR-T: new possibilities and challenges

“…Thus, allo-HCT could be considered to achieve sustainability of response, especially in patients without CR at 30 days post-infusion [8]. Relapses often occur in known pretreatment sites [9]. Therefore, radiotherapy to high-risk lesions could be considered.…”

Targeting CD19 in diffuse large B‐cell lymphoma: An expert opinion paper

“…Lesions at high risk for local failure include high metabolic activity, diameter ≥5 cm, and extranodal disease. It is hypothesized that resistance to CAR T‐cells may occur at the individual lesion level, given that a discordant response to therapy is frequently observed, with some lesions remaining in remission and others progressing 100 …”