Article ; Online: Neurotoxicity and management of primary and secondary central nervous system lymphoma after adoptive immunotherapy with CD19-directed chimeric antigen receptor T-cells.
2024 Volume 25, Issue 12, Page(s) 2239–2249
Abstract: Background: Chimeric antigen receptor (CAR) T-cells targeting CD19 have been established as a leading engineered T-cell therapy for B-cell lymphomas; however, data for patients with central nervous system (CNS) involvement are limited.: Methods: We ... ...
Abstract | Background: Chimeric antigen receptor (CAR) T-cells targeting CD19 have been established as a leading engineered T-cell therapy for B-cell lymphomas; however, data for patients with central nervous system (CNS) involvement are limited. Methods: We retrospectively report on CNS-specific toxicities, management, and CNS response of 45 consecutive CAR T-cell transfusions for patients with active CNS lymphoma at the Massachusetts General Hospital over a 5-year period. Results: Our cohort includes 17 patients with primary CNS lymphoma (PCNSL; 1 patient with 2 CAR T-cell transfusions) and 27 patients with secondary CNS lymphoma (SCNSL). Mild ICANS (grade 1-2) was observed after 19/45 transfusions (42.2%) and severe immune effector cell-associated neurotoxicity syndrome (ICANS) (grade 3-4) after 7/45 transfusions (15.6%). A larger increase in C-reactive protein (CRP) levels and higher rates of ICANS were detected in SCNSL. Early fever and baseline C-reactive protein levels were associated with ICANS occurrence. CNS response was seen in 31 cases (68.9%), including a complete response of CNS disease in 18 cases (40.0%) which lasted for a median of 11.4 ± 4.5 months. Dexamethasone dose at time of lymphodepletion (but not at or after CAR T-cell transfusion) was associated with an increased risk for CNS progression (hazard ratios [HR] per mg/d: 1.16, P = .031). If bridging therapy was warranted, the use of ibrutinib translated into favorable CNS-progression-free survival (5 vs. 1 month, HR 0.28, CI 0.1-0.7; P = .010). Conclusions: CAR T-cells exhibit promising antitumor effects and a favorable safety profile in CNS lymphoma. Further evaluation of the role of bridging regimens and corticosteroids is warranted. |
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MeSH term(s) | Humans ; Immunotherapy, Adoptive/adverse effects ; Receptors, Chimeric Antigen ; C-Reactive Protein ; Retrospective Studies ; Lymphoma/therapy ; Central Nervous System Neoplasms/therapy ; Neurotoxicity Syndromes/etiology ; Neurotoxicity Syndromes/therapy ; Central Nervous System ; T-Lymphocytes |
Chemical Substances | Receptors, Chimeric Antigen ; C-Reactive Protein (9007-41-4) |
Language | English |
Publishing date | 2024-03-13 |
Publishing country | England |
Document type | Journal Article |
ZDB-ID | 2028601-6 |
ISSN | 1523-5866 ; 1522-8517 |
ISSN (online) | 1523-5866 |
ISSN | 1522-8517 |
DOI | 10.1093/neuonc/noad118 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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