Comprehensive Bridging Radiotherapy for Limited Pre-CART Non-Hodgkin Lymphoma

Saifi, Omran; Breen, William G.; Rule, William G.; Lin, Yi; Munoz, Javier; Kharfan-Dabaja, Mohamed A.; Peterson, Jennifer L.

doi:10.1001/jamaoncol.2024.1113

JAMA Oncol

2024

DOI: 10.1001/jamaoncol.2024.1113

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Comprehensive Bridging Radiotherapy for Limited Pre-CART Non-Hodgkin Lymphoma

Omran Saifi,

William G. Breen,

William G. Rule

et al.

Abstract: This cohort study examines the role of comprehensive bridging radiotherapy in the setting of chimeric antigen receptor T-cell therapy for non-Hodgkin lymphoma.

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Cited by 5 publications

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Biomarkers of outcome in patients undergoing CD19 CAR‐T therapy for large B cell lymphoma

Gong,

Tran,

Saibil

et al. 2024

HemaSphere

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CD19‐directed autologous chimeric antigen receptor T cell (CAR‐T) therapy has transformed the management of relapsed/refractory (R/R) large B cell lymphoma (LBCL). Initially approved in the third line and beyond setting, CAR‐T is now standard of care (SOC) for second‐line treatment in patients with refractory disease or early relapse (progression within 12 months) following primary chemoimmunotherapy. Despite becoming SOC, most patients do not achieve complete response, and long‐term cure is only observed in approximately 40% of patients. Accordingly, there is an urgent need to better understand the mechanisms of treatment failure and to identify patients that are unlikely to benefit from SOC CAR‐T. The field needs robust biomarkers to predict treatment outcome, as better understanding of prognostic factors and mechanisms of resistance can inform on the design of novel treatment approaches for patients predicted to respond poorly to SOC CAR‐T. This review aims to provide a comprehensive overview of clinical, molecular, imaging, and cellular features that have been shown to influence outcomes of CAR‐T therapy in patients with R/R LBCL.

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Biomarkers of outcome in patients undergoing CD19 CAR‐T therapy for large B cell lymphoma

Gong,

Tran,

Saibil

et al. 2024

HemaSphere

View full text Add to dashboard Cite

show abstract

Adaptive bridging radiation therapy for relapsed/refractory B-cell lymphoma patient undergoing CAR T-cell therapy: Case report

Ababneh,

Connor Johnson,

Pursley

et al. 2024

Clinical and Translational Radiation Oncology

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Metabolic Tumor Volume Response after Bridging Therapy Determines Chimeric Antigen Receptor T-Cell Outcomes in Large B-Cell Lymphoma

Hubbeling,

Leithner,

Silverman

et al. 2024

Clinical Cancer Research

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Purpose: Greater disease burden is a well-established predictor of poorer outcomes following chimeric antigen receptor T-cell (CAR T) therapy. Although bridging therapy (BT) is widely used between leukapheresis and CAR T infusion, limited data have evaluated the impact of BT on CAR T outcomes. In this study, we hypothesized that the quantitative dynamics of radiomic cytoreduction during bridging are prognostic. Experimental Design: Patients with large B-cell lymphoma treated with CD19-CAR T from 2016 to 2022 were included in the study. Metabolic tumor volume (MTV) was determined for all patients on pre-leukapheresis PET and on post-BT/pre-infusion PET in those who received BT. Patients were stratified into “High” and “Low” disease burden using an MTV cutpoint of 65.4cc established by maximally selected log-rank statistic for progression-free survival (PFS). Results: Of 191 patients treated with CAR T, 144 (75%) received BT. In the BT cohort, 56% had a reduction in MTV post-BT. On multivariate analysis, the MTV trajectory across the bridging period remained significantly associated with PFS (P < 0.001); however, notably, patients with improved MTV (High->Low) had equivalent PFS compared with those with initially and persistently low MTV (Low->Low; HR for High->Low MTV: 2.74; 95% confidence interval, 0.82–9.18). There was a reduction in any grade immune effector cell–associated neurotoxicity syndrome in the High->Low MTV cohort as compared with the High->High MTV cohort (13% vs. 41%; P = 0.05). Conclusions: This is the first study to use radiomics to quantify disease burden pre- and post-BT in a large real-world large B-cell lymphoma cohort. We demonstrate that effective BT can enable initially high–disease burden patients to achieve post–CAR T outcomes comparable with low–disease burden patients.

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Comprehensive Bridging Radiotherapy for Limited Pre-CART Non-Hodgkin Lymphoma

Abstract: This cohort study examines the role of comprehensive bridging radiotherapy in the setting of chimeric antigen receptor T-cell therapy for non-Hodgkin lymphoma.

Cited by 5 publications

References 7 publications

Biomarkers of outcome in patients undergoing CD19 CAR‐T therapy for large B cell lymphoma

Biomarkers of outcome in patients undergoing CD19 CAR‐T therapy for large B cell lymphoma

Adaptive bridging radiation therapy for relapsed/refractory B-cell lymphoma patient undergoing CAR T-cell therapy: Case report

Metabolic Tumor Volume Response after Bridging Therapy Determines Chimeric Antigen Receptor T-Cell Outcomes in Large B-Cell Lymphoma

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