| Autor: |
Di Blasi R; University of Paris APHP, Saint-Louis Hospital, Hemato-oncology, DMU DHI, Paris, France., Le Gouill S; Institut Curie, Paris, France., Bachy E; HCL, Hematology, Lyon, France., Cartron G; CHU Montpellier, Hematology department, UMR CRNS 5535, Montpellier, France., Beauvais D; CHU de Lille, Hematology, Lille, France., Le Bras F; APHP, CHU Créteil, Hematology, Creteil, France., Gros FX; CHU de Bordeaux, Hematology, Bordeaux, France., Choquet S; APHP, Hopital La Pitié Salpetrière, APHP, Hematology, Paris, France., Bories P; Oncopole Toulouse, Hematology, Toulouse, France., Feugier P; Centre Hospitalier Universitaire Nancy and INSERM 1256, Nancy, France., Casasnovas O; CHU Dijon, Bourgogne, France., Bay JO; CHU de Clermont-Ferrand, Hematology, Clermont-Ferrand, France., Mohty M; APHP, Hopital Saint-Antoine, Sorbonne University, Paris, France., Joris M; CHU Amiens, Hematology, Amiens, France., Gastinne T; CHU Nantes, Hematology, Nantes, France., Sesques P; HCL, Hematology, Lyon, France., Tudesq JJ; CHU Montpellier, Hematology department, UMR CRNS 5535, Montpellier, France., Vercellino L; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis Service de médecine nucléaire, Paris, France., Morschhauser F; CHU de Lille, Hematology, Lille, France., Gat E; Institut Carnot CALYM, Lyon, France., Broussais F; LYSARC CHU Lyon Pierre Bénite, Lyon, France., Houot R; CHU Rennes, Rennes, France., Thieblemont C; University of Paris APHP, Saint-Louis Hospital, Hemato-oncology, DMU DHI, Paris, France. |
| Abstrakt: |
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 (© 2022 by The American Society of Hematology.) |
