Treating patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) who are in complete remission at the time of infusion with anti-CD19 chimeric antigen receptor (CAR) T-cell therapy is feasible, safe, and associated with favorable disease control, according to a new study published in the journal Blood Advances.

However, “further exploration in a larger clinical trial setting is warranted,” the study authors said.

Even though CAR T-cell therapy has been revolutionary for the treatment of patients with relapsed/refractory DLBCL, it can cause significant toxicities such as cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, and prolonged cytopenia, Kitsada Wudhikarn, MD, of the Memorial Sloan Kettering Cancer Center in New York City, New York, and colleagues, noted.

Read more about the treatment of DLBCL

In the present study, the researchers analyzed 33 patients with relapsed/refractory DLBCL treated with anti-CD19 CAR T-cell therapy at 8 academic centers. The patients had no detectable disease at the time of treatment.

A total of 9 patients received the CAR T-cell therapy axicabtagene ciloleucel, while the remaining 24 received tisagenlecleucel.

The results showed that none of the patients experienced severe cytokine release syndrome, and only 1 developed neurotoxicity. Of the 33 patients, 13 (39.4%) relapsed after a median follow-up of 16 months. A total of 6 patients died. 

The 1-year event-free survival rate was 59.6%, and the overall survival rate was 81.3%, respectively.

“Patients without detectable lymphoma at the time of anti-CD19 CAR T-cell therapy [have] excellent outcomes,” the researchers concluded. 

DLBCL is a type of non-Hodgkin lymphoma characterized by the abnormal infiltration of B lymphocytes inside tissues and organs in a widespread, diffuse pattern. The standard first-line therapy involves multiagent chemotherapy.

Treatment of patients with relapsed/refractory DLBCL involves second-line chemotherapy, autologous stem cell rescue with or without subsequent radiation, or anti-CD19 CAR T-cell therapy.

Reference

Wudhikarn K, Tomas A, Flynn J, et al. Low toxicity and excellent outcomes in DLBCL patients without residual lymphoma at the time of CD19 CAR T cell therapy. Blood Adv. Published online November 12, 2022. doi:10.1182/bloodadvances.2022008294