| The following article features coverage from the Tandem Meetings 2022. Click here to read more of Cancer Therapy Advisor’s conference coverage. |
Allogeneic transplant after failure of chimeric antigen receptor (CAR) T-cell therapy can be effective for patients with lymphoma, a retrospective study suggests.
Patients with relapsed/refractory large B-cell lymphoma (LBCL) who previously received anti-CD19 CAR T-cell therapy underwent allogeneic hematopoietic stem cell transplant (allo-HSCT) and had durable responses at 1 year, according to Joanna C. Zurko, MD, of the Medical College of Wisconsin in Milwaukee.
Dr Zurko noted that 1-year outcomes in this study were similar to outcomes seen with allo-HSCT for LBCL patients who have not received prior CAR T-cell therapy. She presented these results at the Tandem Meetings 2022.
Continue Reading
Dr Zurko and colleagues evaluated allo-HSCT after CAR-T therapy in 88 patients with relapsed/refractory LBCL. The patients’ median age at transplant was 54 years (range, 19-72), 72% of patients were men, and 66% were White.
Most patients (59%) had de novo diffuse large B-cell lymphoma (DLBCL), 26% had transformed indolent DLBCL, 9.1% had primary mediastinal B-cell lymphoma, and 5.7% had high-grade B-cell lymphoma not otherwise specified.
Before CAR T-cell therapy, patients had received a median of 3 prior lines of therapy (range, 1-7), and 25% of patients had a prior autologous transplant. The CAR T-cell therapies patients received included axicabtagene ciloleucel (67%), lisocabtagene maraleucel (12%), tisagenlecleucel (5%), and investigational CAR-T therapy (16%).
The median time between CAR-T therapy and allo-HSCT was 8.4 months (range, 2.1-24.8 months). During this time, patients received a median of 1 line of therapy (range, 0-7).
Right before transplant, 51% of patients had achieved a complete response (CR), 25% had a partial response, and 24% had stable or progressive disease.
Most patients received non-myeloablative conditioning (77%). Donor types included matched unrelated (39%), haploidentical (30%), matched related (26%), mismatched unrelated (3%), and cord blood (2%).
Results
The median follow-up after allo-HSCT was 15.0 months (range, 1-72 months). The cumulative incidence of neutrophil recovery was 94% at 28 days, and the cumulative incidence of platelet recovery was 85% at 100 days. One patient had graft failure.
At 100 days, the cumulative incidence of grade 2-4 acute graft-vs-host disease (GVHD) was 34%, and the incidence of grade 3-4 acute GVHD was 10%. At 1 year, 30% of patients had chronic GVHD.
The median progression-free survival (PFS) was 10 months, and the median overall survival (OS) was 21 months. The 1-year PFS rate was 45%, and the 1-year OS rate was 59%. The 1-year non-relapse mortality rate was 22%, and the rate of relapse or progression was 33%.
On multivariate analysis, inferior PFS was significantly associated with a higher number of treatment lines between CAR-T therapy and allo-HSCT as well as a lack of CR prior to allo-HSCT.
Inferior OS was significantly associated with both aforementioned factors as well as Hispanic ethnicity. Inferior non-relapse mortality was significantly associated with all 3 aforementioned factors as well as receiving a myeloablative conditioning regimen.
“Based on these findings, we believe that transplant-eligible patients, at least those who achieve a CR after CAR-T failure, should be considered for allogeneic transplant at this time,” Dr Zurko said.
She also emphasized the need for long-term follow-up to confirm the durable remission rate and curative potential of allo-HSCT after CAR-T failure.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Read more of Cancer Therapy Advisor’s coverage of Tandem Meetings 2022 by visiting the conference page.
Reference
Zurko JC, Ramdial J, Ahmed S, et al. Allogeneic hematopoietic cell transplantation for relapsed/refractory large B-cell lymphoma after CAR T-cell therapy failure. Tandem Meetings 2022; April 23-26, 2022. Abstract 8.
