Patients with diffuse large B cell lymphoma (DLBCL) with partial response to axicabtagene ciloleucel (axi-cel) may benefit from nivolumab treatment, according to a new study published in the British Journal of Haematology.
However, “this subgroup of patients needs to be further studied before this strategy can be broadly advised,” the study authors noted.
Read more about the treatment of DLBCL
The study reported results from 11 patients with relapsed/refractory DLBCL who did not achieve complete remission following CD19-directed CAR T-cell therapy using axi-cel. The patients were then treated with 240 mg/m2 of nivolumab every 2 weeks.
The patients belonged to one of 3 groups, those who had stable or progressive disease after axi-cel treatment (n=5), those in partial response after axi-cel treatment (n=2), and those who progressed after an initial partial response following axi-cel treatment (n=4).
All patients with stable or progressive disease after axi-cel treatment experienced disease progression 60 days after nivolumab treatment, and 4 of them died after a median of 527 days.
The 2 patients who had a partial response after axi-cel treatment finally achieved a complete response after nivolumab treatment.
Finally, 2 of the patients who progressed after an initial partial response following axi-cel treatment achieved complete response, while the other 2 had progressive disease.
“The two responding patients are still alive at 2 years post-nivolumab,” the researchers wrote, “One subsequently received allogeneic transplant and relapsed at 1 year, and the other developed a mesenteric relapse 1 year after nivolumab, successfully treated by radiotherapy.”
They concluded that nivolumab seems not to be effective in DLBCL patients’ refractory to CAR T-cell therapy. However, it seems to improve upon partial response inducing a second CAR T-cell expansion without cytokine release syndrome or neurotoxicity.
Reference
Gazeau N, Mitra S, Nudel M, et al. Safety and efficacy of nivolumab in patients who failed to achieve a complete remission after CD19-directed CAR T-cell therapy in diffuse large B cell lymphoma. Br J Haematol. Published online March 31, 2023. doi:10.1111/bjh.18775
