These Factors Predict Early Progression Following CAR-T Therapy in DLBCL

A study published in Blood Advances observed that extranodal involvement and lymphoma burden are risk factors for early progression at the time of diagnosis and time of treatment for patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) being treated with chimeric antigen receptor (CAR) T-cell therapy.

Researchers sought to identify factors that may predict CAR T-cell failure, particularly early progression, within the first month after infusion. The study included 116 patients (median age, 60.7 years) with relapsed/refractory DLBCL who were analyzed at the time of decision to use commercial CAR T-cell treatment and at the time of treatment. Patients were treated at five French Lymphoma Study Association centers between June 2018 and January 2020.

Median time from decision to apheresis was nine days (range, 5.5-16.5 days), and the median time between apheresis and infusion was 40 days (range, 36-45 days). After a median follow-up of 8.2 months, 55 patients relapsed; 49% of relapses (n=27) occurred within the first month after infusion.

The estimated 12-month progression-free survival (PFS) and overall survival (OS) were 47.2% (95% confidence interval [CI], 38.0-58.6) and 67.0% (95% CI, 57-79), respectively.

Univariate analyses for PFS and OS found that the following characteristics predicted CAR T-cell failure: Eastern Cooperative Oncology Group performance status score of ≥2, stage III/IV disease, two or more extranodal sites, elevated lactate dehydrogenase (LDH), increased C-reactive protein (CRP), high International Prognostic Index at time of decision and time of treatment, as well as increased CRP, bulky mass, and high total metabolic tumor volume at time of treatment.

Multivariate analyses for early progression, PFS, and OS identified elevated LDH and two or more extranodal sites at time of decision and the same predictors at time of treatment (i.e., increased CRP, two or more extranodal sites, and total metabolic tumor volume >80 mL), the authors noted.

“Our risk model identifying early failure [risk factors] should assist in better selection of these patients for CAR T-cell therapy,” the researchers concluded.