Several clinical and radiographic parameters may be helpful in predicting the progression of refractory/relapsed diffuse large B-cell lymphoma (DLBCL) and the survival of patients receiving treatment with chimeric antigen receptor T-cell (CAR-T) therapy, according to a study published in Clinical Lymphoma, Myeloma & Leukemia.

A multivariate logistic model identified international prognostic index (IPI) score [odds ratio (OR), 2.828; P =.014], absolute lymphocyte count ≥0.50 at collection (OR, 0.183; P =.043), C-reactive protein (CRP) ≥11 (OR, 6.177; P =.019), and tocilizumab administration (OR, 0.062; P =.005) as predictors for overall survival at 1 year. Taken together, these predictors could create a model with an area under the curve (AUC) of .8626 (P <.001).

A multivariate Cox proportional hazards model also identified IPI (OR, 1.903; P =.007) and tocilizumab administration (OR, 0.219; P =.005) as predictors for death at day 365 and also identified ferritin level prior to CAR-T therapy (OR, 1.001; P =.010) as a predictor.

Read more about DLBCL prognosis

For disease progression, the logistic model only identified stage IV disease as a predictor for disease progression (OR, 9.335; P <.025), which yielded an AUC of .7922 (P <.001). The final multivariate hazards model only included CRP ≥11 (HR, 3.901, P <.001) for disease progression.

“This analysis identifies clinical variables that are predictive of progression and survival in patients with relapsed/refractory non-Hodgkin’s B cell lymphomas who receive CAR T-cell therapy,” the authors said. “These variables need to be validated in prospective testing cohorts but have the potential to greatly improve patient selection for and monitoring after anti-CD19 CAR T-cell therapy.”

The response to CAR-T therapy at 90 days included an overall response rate of 51.7% and a complete response rate of 39.7%, and the rate of progression was 44.8%. At day 365, the overall response rate had become 38.5%, the complete response rate was 35.1%, and the rate of progression was 61.4%.

A total of 59 patients who received CAR-T therapy were included in the retrospective analysis, including 56 DLBCL patients, 2 primary mediastinal B-cell lymphoma patients, and 1 follicular lymphoma patient. The median overall survival was not reached after a median follow-up of 25.6 months, and 30 patients remained alive. The median progression-free survival was 5.7 months, and 35 patients had disease progression.

Reference

Jodon G, Colton MD, Abbott D, et al. Clinical and radiographic predictors of progression and survival in relapsed/refractory lymphoma patients receiving anti-CD19 CAR T-cell therapy. Clin Lymphoma Myeloma Leuk. Published online October 7, 2022. doi:10.1016/j.clml.2022.09.009