Systematic review and meta-analysis of the association between bridging therapy and outcomes of chimeric antigen receptor T cell therapy in patients with large B cell lymphoma

Sun, Zhenliang; Liu, MengSi

doi:10.1016/j.jcyt.2022.03.009

Cited by 5 publications

(4 citation statements)

References 51 publications

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“…The use of BT has been of interest as a prognostic marker since patients with more aggressive disease may require bridging therapy. Studies have associated BT with mixed results, as one meta-analysis demonstrated that patients who received BT had a worse 1-year OS rate compared to those who did not; however, this discrepancy in outcomes may be explained by the heterogeneity in underlying disease status at baseline [ 16 ]. The trials that studied the three approved CAR T-cell products in second-line R/R LBCL each differed in their design with regard to incorporating BT.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Chimeric Antigen Receptor (CAR) T-Cell Therapy in Patients with Large B-Cell Lymphoma (LBCL): A Single-Institution Experience

Trando,

Ter-Zakarian,

Yeung

et al. 2023

Cancers

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Chimeric antigen receptor T-cell (CAR T-cell) therapy has revolutionized the treatment of relapsed/refractory (R/R) large B-cell lymphoma (LBCL). We describe the real-world baseline characteristics, efficacy, safety, and post-relapse outcomes of adult patients with R/R LBCL who received CAR T-cell therapy at the University of California San Diego. A total of 66 patients with LBCL were treated with tisagenlecleucel or axicabtagene ciloleucel. The median age was 59.5, and 21% were over 70 years old. Additionally, 20% of the patients had an Eastern Cooperative Oncology Group (ECOG) performance score of ≥2. Cytokine release syndrome incidence was 88%; immune effector cell-associated neurotoxicity syndrome incidence was 56%. All-grade infection occurred in 48% of patients and in 79% of patients > 70 years old. Complete response (CR) was achieved in 53% and partial response in 14%. Median progression-free survival (PFS) was 10.3 months; median overall survival (OS) was 28.4 months. Patients who relapsed post-CAR T-cell therapy had poor outcomes, with a median OS2 of 4.8 months. Upon multivariate analysis, both ECOG (HR 2.65, 95% CI: 1.30–5.41; p = 0.007) and ≥2 sites of extranodal involvement (HR 2.22, 95% CI: 1.15–4.31; p = 0.018) were significant predictors of PFS. Twenty-six patients were R/R to CAR T-cell therapy; six patients were in remission at the time of data cut off, one of whom received allogeneic transplant. Overall, older patients can safely undergo CAR T-cell therapy, despite the increased risk of all-grade infection. In our cohort, ECOG performance score and ≥2 sites of extranodal disease are significant predictors of PFS.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Chimeric Antigen Receptor (CAR) T-Cell Therapy in Patients with Large B-Cell Lymphoma (LBCL): A Single-Institution Experience

Trando,

Ter-Zakarian,

Yeung

et al. 2023

Cancers

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“…The effect of bridging RT on the outcome of CAR‐T‐cell therapy needs to be documented in controlled trials. Patients needing bridging therapy, either RT or systemic treatment, seem to have a poorer prognosis, which is not surprising as they needed the bridging therapy for a reason 30,37 . However, patients who were bridged with RT had better outcomes than patients who were breached with systemic treatments, but this might be attributed to more aggressive disease 30,37 .…”

Section: Bridgingmentioning

confidence: 99%

“…Patients needing bridging therapy, either RT or systemic treatment, seem to have a poorer prognosis, which is not surprising as they needed the bridging therapy for a reason 30,37 . However, patients who were bridged with RT had better outcomes than patients who were breached with systemic treatments, but this might be attributed to more aggressive disease 30,37 . RT seems to be a preferable bridging strategy, but the available evidence is hampered by the fact that studies are small and retrospective with heterogeneity in RT dose and fractionation, varying RT field sizes, and varied response assessments 27,37 …”

Section: Bridgingmentioning

confidence: 99%

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Reappraisal of the role of radiation therapy in lymphoma treatment

Specht

2023

Hematological Oncology

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Radiation therapy (RT) for lymphomas has improved dramatically with modern imaging and treatment techniques, encompassing only the necessary volume with minimal doses to normal structures. Prescribed radiation doses are reduced, and fractionation schedules are under revision. With effective systemic treatment only initial macroscopic disease is irradiated. With no or less effective systemic treatment, possible microscopic disease is also included. Risks of long‐term side effects of RT have diminished dramatically and should be weighed against risks from more systemic treatment or increased risk of relapse. Lymphoma patients are often elderly, they tolerate modern limited RT very well. Lymphomas refractory to systemic treatments often remain radioresponsive, and brief, mild RT may offer effective palliation. New roles for RT are emerging with immune therapies. RT for “bridging,” keeping the lymphoma under control while waiting for immune therapy, is well established. Enhancement of the immune response to lymphomas, so‐called “priming,” is being intensively researched.

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Chimeric antigen receptor T-cell immunotherapies adverse events reported to FAERS database: focus on cytopenias

Gomez-Lumbreras,

Mercadal Vilchez,

Villa-Zapata

et al. 2023

Leukemia & Lymphoma

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Systematic review and meta-analysis of the association between bridging therapy and outcomes of chimeric antigen receptor T cell therapy in patients with large B cell lymphoma

Cited by 5 publications

References 51 publications

Outcomes of Chimeric Antigen Receptor (CAR) T-Cell Therapy in Patients with Large B-Cell Lymphoma (LBCL): A Single-Institution Experience

Outcomes of Chimeric Antigen Receptor (CAR) T-Cell Therapy in Patients with Large B-Cell Lymphoma (LBCL): A Single-Institution Experience

Reappraisal of the role of radiation therapy in lymphoma treatment

Chimeric antigen receptor T-cell immunotherapies adverse events reported to FAERS database: focus on cytopenias

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