Outcomes of patients with secondary central nervous system lymphoma following CAR T-cell therapy: A multicenter cohort study Correspondence
| Authors: | Epperla, N.; Feng, L.; Shah, N. N.; Fitzgerald, L.; Shah, H.; Stephens, D. M.; Lee, C. J.; Ollila, T.; Shouse, G.; Danilov, A. V.; David, K. A.; Torka, P.; Hashmi, H.; Hess, B.; Barta, S. K.; Romancik, J. T.; Cohen, J. B.; Annunzio, K.; Kittai, A. S.; Reneau, J.; Zurko, J.; Nizamuddin, I. A.; Winter, J. N.; Gordon, L. I.; Ma, S.; Patel, R.; Nastoupil, L.; Ahmed, S.; Karmali, R. |
| Title: | Outcomes of patients with secondary central nervous system lymphoma following CAR T-cell therapy: A multicenter cohort study |
| Abstract: | Chimeric antigen receptor T-cell therapy (CAR-T) has been successful in treating relapsed/refractory B-cell lymphomas. However, its role in the treatment of diseases involving the central nervous system (CNS) is not well studied. We performed a multicenter retrospective cohort study to evaluate the outcomes of patients with secondary CNS lymphoma (SCNSL) who received CAR-T. Eligibility required active CNSL at the time of apheresis. The objectives included evaluation of overall survival (OS), progression-free survival (PFS), identification of predictors of complete response (CR) post-CAR-T, and assessment of risk factors for cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Sixty-one patients were included in the analysis. The overall response rate was 68% with a CR rate of 57%. In the multivariable analysis, patients who experienced any grade CRS had higher odds of achieving CR (OR = 3.9, 95% CI = 1.01–15.39, p = 0.047). The median PFS was 3.3 months (95% CI = 2.6–6.0 months) with 6- and 12-month PFS rates of 35% and 16%, respectively. The median OS was 7.6 months (95% CI = 5.0–13.5 months) with 6- and 12-month OS rates of 59% and 41%, respectively. Any grade CRS and ICANS were 70% (n = 43) and 57% (n = 34), respectively with grade ≥ 3 CRS and ICANS rates of 16% and 44%. Factors associated with increased risk of CRS and ICANS included receiving axi-cel or having leptomeningeal ± parenchymal + CNS involvement, respectively. Despite achieving high response rates, most patients experience early relapse or death following CAR-T in SCNSL. The current study provides a benchmark for future trials exploring novel therapeutic options in SCNSL. © 2023, The Author(s). |
| Keywords: | adult; aged; retrospective studies; major clinical study; overall survival; clinical trial; methotrexate; drug megadose; neurotoxicity; letter; progression free survival; cohort analysis; retrospective study; central nervous system tumor; central nervous system; central nervous system neoplasms; multicenter study; tumor recurrence; lymphoma; chimeric antigen receptor; lymphoma, large b-cell, diffuse; neoplasms, second primary; outcomes; follicular lymphoma; marginal zone lymphoma; adoptive immunotherapy; immunotherapy, adoptive; cd19 antigen; antigens, cd19; cytokine release syndrome; diffuse large b cell lymphoma; cancer prognosis; pfs; humans; human; male; female; secondary central nervous system lymphoma; car-t; os; central nervous system cancer; ecog performance status; tisagenlecleucel t; chimeric antigen receptor t-cell immunotherapy; axicabtagene ciloleucel; lisocabtagene maraleucel; receptors, chimeric antigen; secondary cns lymphoma; brexucabtagene autoleucel; cell-associated neurotoxicity; second primary neoplasm; meningeal tumor; scnsl |
| Journal Title: | Journal of Hematology & Oncology |
| Volume: | 16 |
| ISSN: | 1756-8722 |
| Publisher: | Biomed Central Ltd |
| Date Published: | 2023-01-01 |
| Start Page: | 111 |
| Language: | English |
| DOI: | 10.1186/s13045-023-01508-3 |
| PUBMED: | 37946255 |
| PROVIDER: | scopus |
| PMCID: | PMC10633964 |
| DOI/URL: | |
| Notes: | Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
Related MSK Work