Outcomes among adult recipients of CD19 CAR T-cell therapy for Burkitt lymphoma.

Abstract

7571 Background: Burkitt lymphoma (BL) is a rare, but highly aggressive B-cell lymphoma associated with especially poor outcomes in patients with relapsed/refractory disease. Multiple CD19 chimeric antigen receptor (CAR) T-cell products have been FDA approved to treat relapsed/refractory B-cell non-Hodgkin lymphoma in the second-line setting, however little is known about CAR T-cell responses in patients with BL. This multicenter study aims to assess real-world outcomes among patients with BL treated with CAR T-cell therapy across the United States. Methods: This multicenter, retrospective chart review was conducted by abstracting data from the medical charts of patients with BL who received CAR T-cell therapy. Demographic characteristics were assessed along with pre-CAR treatments, bridging therapies, infusion-related complications, CAR-T responses, and the use of post-CAR systemic therapy and/or hematopoietic stem cell transplant. Results: A total of 13 patients with relapsed/refractory BL received CAR T-cell therapy after a median of 3 prior therapies (range 1-6). Most patients received axi-cel (n = 8), although tisa-cel (n = 3) and liso-cel (n = 2) were also represented. The median age of these patients was 38 (range 24-68). A total of 6 (46.2%) had evidence of central nervous system involvement at diagnosis and 5 (38.5%) had a prior history of autologous stem cell transplant. The overall response rate 1 month after infusion was 69.2% with a complete response rate of 53.8%. All patients experienced grade 1-2 cytokine release syndrome (CRS). No one experienced grade ≥3 CRS, but 2 patients developed grade ≥3 immune effector cell-associated neurotoxicity syndrome (ICANS). Twenty-eight-day mortality was 23%, including one patient who died from grade 4 ICANS. Regarding long term data, only 4 (30.8%) patients sustained a complete response for more than 6 months. Median progression-free survival was 4.2 months (95% CI 28.2-257.6), and the 1-year overall survival rate was 61.5% (95% CI 0.56-0.67). Two (15.4%) patients received consolidative allogeneic stem cell transplants after CAR T-cell therapy, but both ultimately developed progressive disease. Conclusions: Relapsed/refractory BL is a rare and aggressive disease that remains challenging to treat despite the advent of CAR T-cell therapy. Further investigation is needed to determine the most effective management of these patients. We expect to include additional patients in this analysis over the coming months.

Bone Marrow Aplasia after CAR-T-Cell Therapy for Relapsed/Refractory Burkitt’s Lymphoma

“…In addition, cytopenias are common post-CAR-T, although typically recovering quickly, making patients susceptible to severe infection. More recent data paint an even more dismal picture of outcomes in this group [ 25 ]. Of 13 patients that received CAR-T with R/R BL in this study, CR was seen in 53.6%, with only 30.8% having a sustained response of more than 6 months [ 25 ].…”

“…More recent data paint an even more dismal picture of outcomes in this group [ 25 ]. Of 13 patients that received CAR-T with R/R BL in this study, CR was seen in 53.6%, with only 30.8% having a sustained response of more than 6 months [ 25 ]. Median progression-free survival was 4.2 months [ 25 ].…”

“…Of 13 patients that received CAR-T with R/R BL in this study, CR was seen in 53.6%, with only 30.8% having a sustained response of more than 6 months [ 25 ]. Median progression-free survival was 4.2 months [ 25 ]. Additional investigation is warranted to decipher more effective treatments in this patient population.…”