Bridging therapy prior to axicabtagene ciloleucel for relapsed/refractory large B-cell lymphoma.

Abstract

The impact of bridging therapy (BT) administered between leukapheresis and chimeric antigen receptor (CAR) T-cell therapy for large B-cell lymphoma (LBCL) is unclear. We evaluated the influence of BT (systemic therapy [ST], radiation therapy [RT], or combined-modality therapy [CMT]) on outcomes of 148 LBCL patients who underwent leukapheresis for planned axicabtagene ciloleucel (axi-cel) infusion. The 55% (n = 81) of patients who received BT were more likely to have international prognostic index (IPI) score ≥3 (P ≤ .01), bulky disease (P = .01), and elevated lactate dehydrogenase (LDH; P ≤ .01). The 1-year progression-free (PFS) and overall survival (OS) rates were 40% and 65% in non-BT patients vs 21% and 48% in BT patients (P = .01 and .05, respectively). Twenty-four patients (16%) did not receive axi-cel, most commonly because of lymphoma progression (88%), despite 80% (n = 19) receiving BT. Among 124 patients who received axi-cel, 50% (n = 62) received BT with ST (n = 45), RT (n = 11), or CMT (n = 6); 1-year PFS and OS rates were not significantly different between BT and non-BT cohorts (P = .06 and .21, respectively). There was no difference in proportion of patients with IPI ≥3, limited-stage disease, or elevated LDH between ST, RT, and CMT groups. Compared with non-BT patients, 1-year PFS was inferior for ST-bridged patients (P = .01). RT-bridged patients had improved PFS compared with ST-bridged patients (P = .05). Despite the poor prognosis associated with requiring BT, RT can be an effective bridging strategy. Future studies are necessary to identify strategies that may improve access to CAR T-cell therapy and outcomes.

• Authors: Chelsea C Pinnix, Jillian R Gunther, Bouthaina S Dabaja, Paolo Strati, Penny Fang, Misha C Hawkins, Sherry Adkins, Jason Westin, Sairah Ahmed, Luis Fayad, Hun Ju Lee, Ranjit Nair, Raphael E Steiner, Swaminathan P Iyer, M Alma Rodriguez, Michael Wang, Christopher Flowers, Sattva S Neelapu, Loretta J Nastoupil
• Journal: Blood advances (Blood Adv) Vol. 4 Issue 13 Pg. 2871-2883 (07 14 2020) ISSN: 2473-9537 [Electronic] United States
• PMID: 32589728 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: © 2020 by The American Society of Hematology.

Chemical References

• Antigens, CD19
• Biological Products
• axicabtagene ciloleucel

Topics

• Antigens, CD19 (therapeutic use)
• Biological Products
• Humans
• Immunotherapy, Adoptive
• Lymphoma, Large B-Cell, Diffuse (drug therapy)
• Survival Rate