Outcomes of patients with aggressive B-cell lymphoma after failure of anti-CD19 CAR T-cell therapy: a DESCAR-T analysis
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- Roberta Di Blasi
- 1University of Paris APHP, Saint-Louis Hospital, Hemato-oncology, DMU DHI, Paris, France
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- Steven Le Gouill
- 2Institut Curie, Paris, France
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- Emmanuel Bachy
- 3HCL, Hematology, Lyon, France
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- Guillaume Cartron
- 4CHU Montpellier, Hematology department, UMR CRNS 5535, Montpellier, France
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- David Beauvais
- 5CHU de Lille, Hematology, Lille, France
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- Fabien Le Bras
- 6APHP, CHU Créteil, Hematology, Creteil, France
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- François-Xavier Gros
- 7CHU de Bordeaux, Hematology, Bordeaux, France
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- Sylvain Choquet
- 8APHP, Hopital La Pitié Salpetrière, APHP, Hematology, Paris, France
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- Pierre Bories
- 9Oncopole Toulouse, Hematology, Toulouse, France
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- Pierre Feugier
- 10Centre Hospitalier Universitaire Nancy and INSERM 1256, Nancy, France
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- Olivier Casasnovas
- 11CHU Dijon, Bourgogne, France
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- Jacques Olivier Bay
- 12CHU de Clermont–Ferrand, Hematology, Clermont-Ferrand, France
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- Mohamad Mohty
- 13APHP, Hopital Saint-Antoine, Sorbonne University, Paris, France
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- Magalie Joris
- 14CHU Amiens, Hematology, Amiens, France
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- Thomas Gastinne
- 15CHU Nantes, Hematology, Nantes, France
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- Pierre Sesques
- 3HCL, Hematology, Lyon, France
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- Jean-Jacques Tudesq
- 4CHU Montpellier, Hematology department, UMR CRNS 5535, Montpellier, France
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- Laetitia Vercellino
- 16Assistance Publique–Hôpitaux de Paris, Hôpital Saint-Louis Service de médecine nucléaire, Paris, France
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- Franck Morschhauser
- 5CHU de Lille, Hematology, Lille, France
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- Elodie Gat
- 17Institut Carnot CALYM, Lyon, France
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- Florence Broussais
- 18LYSARC CHU Lyon Pierre Bénite, Lyon, France
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- Roch Houot
- 19CHU Rennes, Rennes, France
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- Catherine Thieblemont
- 1University of Paris APHP, Saint-Louis Hospital, Hemato-oncology, DMU DHI, Paris, France
説明
<jats:title>Abstract</jats:title> <jats:p>Anti-CD19 chimeric antigen receptor (CAR) T-cells represent a major advance in the treatment of relapsed/refractory aggressive B-cell lymphomas. However, a significant number of patients experience failure. Among 550 patients registered in the French registry DESCAR-T, 238 (43.3%) experienced progression/relapse, with a median follow-up of 7.9 months. At registration, 57.0% of patients presented an age-adjusted International Prognostic Index of 2 to 3, 18.9% had Eastern Cooperative Oncology Group performance status ≥2, 57.1% received >3 lines of treatment prior to receiving CAR T-cells, and 87.8% received bridging therapy. At infusion, 66% of patients presented progressive disease, and 38.9% had high lactate dehydrogenase (LDH). Failure after CAR T-cell treatment occurred after a median of 2.7 months (range: 0.2-21.5). Fifty-four patients (22.7%) presented very early failure (day [D] 0-D30); 102 (42.9%) had early failure (D31-D90), and 82 (34.5%) had late (>D90) failure. After failure, 154 patients (64%) received salvage treatment: 38.3% received lenalidomide, 7.1% bispecific antibodies, 21.4% targeted treatment, 11% radiotherapy, and 20% immunochemotherapy with various regimens. Median progression-free survival was 2.8 months, and median overall survival (OS) was 5.2 months. Median OS for patients failing during D0-D30 vs after D30 was 1.7 vs 3.0 months, respectively (P = .0001). Overall, 47.9% of patients were alive at 6 months, but only 18.9% were alive after very early failure. In multivariate analysis, predictors of OS were high LDH at infusion, time to CAR-T failure <D30, and high C-reactive protein at infusion. This multicentric analysis confirms the poor outcome of patients relapsing after CAR T-cell treatment, highlighting the need for further strategies dedicated to this population.</jats:p>
収録刊行物
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- Blood
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Blood 140 (24), 2584-2593, 2022-12-15
American Society of Hematology