Factors Affecting Outcome of Bridging Radiotherapy (RT) Before CAR-T for High Grade Lymphoma
| Autor: | M. Cuadrado, R. Sanderson, C. Gillham, Reuben Benjamin, E. Alexander, R. Evans, A. Bates, V. Poetter, I. Vasiliadou, J.L. Brady, Piers Em Patten, G. Mikhaeel, J. Summers, Andrea Kuhnl, T. Ajithkumar |
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| Rok vydání: | 2021 |
| Předmět: |
Cancer Research
High-grade lymphoma medicine.medical_specialty Radiation Performance status business.industry Proportional hazards model medicine.medical_treatment Disease medicine.disease Gastroenterology Radiation therapy Oncology Internal medicine Toxicity medicine Radiology Nuclear Medicine and imaging Car t cells business Progressive disease |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 111:e309 |
| ISSN: | 0360-3016 |
| DOI: | 10.1016/j.ijrobp.2021.07.962 |
| Popis: | Purpose/Objective(s) CD19 CAR-T therapy is the most effective salvage in chemo-refractory high-grade NHL. During manufacturing many patients (pts) require bridging therapy to halt disease progression and RT is one of the options due to its potential to control chemo-refractory disease. However, data guiding selection of pts who may benefit from bridging RT is limited and choice is usually made on the basis of disease extent only. In this study we examined factors which may affect outcome after RT bridging and CAR-T therapy Materials/Methods We reviewed all pts treated with bridging RT prior to CAR-T therapy in our institution from April 2019-January 2021. Data collected included pt characteristics, disease and treatment details, outcomes including relapse and survival. Results 27 pts received bridging RT. Median age was 57 years (19-79), 63% were male and 89% a performance status of 0-1. Table 1 shows disease & RT treatment details. 23 pts were infused (1 not infused due to infection and 3 pending). All but 1 completed planned RT and RT was well tolerated; only 1 pt had grade 3 toxicity. Of 23 pts available for outcome analysis, 22 had PET-CT after RT prior to CAR-T. 21 (91.3%) had partial metabolic response (PMR) or complete metabolic response (CMR) in RT field, but 12 of these had progressive disease out of field. At a median follow-up of 8.8 months (0.6-20.6); 12 pts have relapsed; 2 in-field; 5 out-of-field and 5 in both. 16 (69.6%) pts achieved local control with CMR (12; 52.2%) or PMR (4; 17.4%). Median PFS was 5.1 months (95% CI 0.0-11.9 months) and median OS was 17.8 months (95% CI 12.7-22.9 months). On Cox regression analysis bulky disease was associated with a significantly worse PFS (HR 1.05; 95% CI 1.0-1.07; P = 0.05) and OS (HR 1.07; 95% CI 1.01-1.13; P = 0.027). Relapse was less common in pts achieving CMR at some point compared to pts who did not (3/10 vs 9/13; χ2 = 0.06). Relapse rate at 12 months was higher with SUV max > 20 (8/13 vs 4/10, χ2 = 0.3); but was not affected by bulky disease ( Conclusion RT bridging prior to CAR-T therapy is an effective and well tolerated with 69.9% achieving local control. RT did not result in complications preventing infusion. Bulky disease, CTV size, RT dose, and RT extent did not affect local control. SUV max > 20 showed a trend towards a worse relapse rate and bulky disease was associated with a worse PFS and OS. |
| Databáze: | OpenAIRE |
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