放射桥接疗法增强大B细胞淋巴瘤中CAR-T细胞疗效：一项单中心真实世界经验
Enhancing CAR-T Efficacy in Large B-Cell Lymphoma with Radiation Bridging Therapy: A Real-World Single-Center Experience.
作者信息
Laverdure Eva, Mollica Luigina, Ahmad Imran, Cohen Sandra, Lachance Silvy, Veilleux Olivier, Bernard Maryse, Marchand Eve-Lyne, Delisle Jean-Sébastien, Bernard Lea, Boileau Mélissa, Petrella Tony, Pilon Sarah-Jeanne, Bouchard Philippe, Roy Denis-Claude, Busque Lambert, Fleury Isabelle
机构信息
Department of Medicine, Institut Universitaire d'Hémato-Oncologie et de Thérapie Cellulaire, Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est-de-l'Île-de-Montréal, l, Montréal, QC HIT 2M4, Canada.
Department of Hemato-Oncology, Hôpital Fleurimont, Centre Hospitalier Universitaire de Sherbrooke, CIUSSS de l'Estrie, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada.
出版信息
Curr Oncol. 2025 Mar 17;32(3):173. doi: 10.3390/curroncol32030173.
One challenge of chimeric antigen receptor T-cell therapy (CAR-T) for relapsed or refractory large B-cell lymphoma (LBCL) is achieving disease control during manufacturing. We report real-word outcomes of 100 patients treated with axicabtagene ciloleucel (axi-cel, = 50) or tisagenlecleucel (tisa-cel, = 50) at our center. Most patients received bridging therapy (BT) with 48 undergoing radiation BT (RBT) and 32 receiving systemic BT (SBT). The best overall response rate (ORR) was 84% (78% complete response (CR)) for axi-cel and 60% (42% CR) for tisa-cel. At a median follow-up of 16 months, 12-month progression-free survival (PFS) and overall survival (OS) were 72% and 82% for axi-cel, compared to 35% and 57% for tisa-cel. By the bridging approach, 12-month PFS was 60% with RBT, 59% without BT and 35% with SBT ( = 0.06). Notably, axi-cel patients without lymphoma progression during manufacturing ( = 24) achieved 12-month PFS and OS rates of 91% and 96%, respectively. Axi-cel was associated with more cytokine release syndrome (92% vs. 66%, = 0.003) and neurotoxicity (all-grade 56% vs. 10%, < 0.001, grade ≥ 328% vs. 4%, = 0.002). Multivariate analysis identified RBT as independently associated with improved PFS (HR 0.46, 95% CI 0.22-0.96). Pending prospective validation, RBT shows promise for improving CAR-T outcomes in LBCL.
嵌合抗原受体T细胞疗法（CAR-T）用于复发或难治性大B细胞淋巴瘤（LBCL）的一个挑战是在制造过程中实现疾病控制。我们报告了在我们中心接受阿基仑赛注射液（axi-cel，n = 50）或替雷利珠单抗注射液（tisa-cel，n = 50）治疗的100例患者的真实世界结果。大多数患者接受了桥接治疗（BT），其中48例接受了放疗桥接治疗（RBT），32例接受了全身桥接治疗（SBT）。阿基仑赛注射液的最佳总体缓解率（ORR）为84%（完全缓解（CR）率为78%），替雷利珠单抗注射液为60%（CR率为42%）。在中位随访16个月时，阿基仑赛注射液的12个月无进展生存期（PFS）和总生存期（OS）分别为72%和82%，而替雷利珠单抗注射液分别为35%和57%。通过桥接方法，RBT的12个月PFS为60%，无BT为59%，SBT为35%（P = 0.06）。值得注意的是，在制造过程中无淋巴瘤进展的阿基仑赛注射液患者（n = 24）的12个月PFS和OS率分别为91%和96%。阿基仑赛注射液与更多的细胞因子释放综合征（92%对66%，P = 0.003）和神经毒性相关（所有级别56%对10%，P < 0.001，≥3级28%对4%，P = 0.002）。多变量分析确定RBT与改善的PFS独立相关（风险比0.46，95%置信区间0.22 - 0.96）。在进行前瞻性验证之前，RBT显示出改善LBCL中CAR-T治疗结果的前景。
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