Radiation therapy as bridging and salvage strategy among patients with secondary central nervous system lymphoma undergoing CD19‐targeted chimeric antigen receptor T‐cell therapy

Ababneh, Hazim S.; Frigault, Matthew J.; Ng, Andrea K.; Patel, Chirayu G.

doi:10.1002/hon.3243

Hematological Oncology

2023

DOI: 10.1002/hon.3243

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Radiation therapy as bridging and salvage strategy among patients with secondary central nervous system lymphoma undergoing CD19‐targeted chimeric antigen receptor T‐cell therapy

Hazim S. Ababneh,

Matthew J. Frigault,

Andrea K. Ng

et al.

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Cited by 2 publications

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The contemporary spectrum of radiotherapy for hematologic malignancies involving the central nervous system: From focal therapy to craniospinal

Cederquist,

Tringale,

Yahalom

et al. 2025

Seminars in Radiation Oncology

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The contemporary spectrum of radiotherapy for hematologic malignancies involving the central nervous system: From focal therapy to craniospinal

Cederquist,

Tringale,

Yahalom

et al. 2025

Seminars in Radiation Oncology

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CNS bridging radiotherapy achieves rapid cytoreduction before CAR T-cell therapy for aggressive B-cell lymphomas

Cederquist,

Schefflein,

Devlin

et al. 2024

Blood Advances

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CAR T-cell therapy (CAR T) for central nervous system lymphoma (CNSL) is a promising strategy, yet responses are frequently not durable. Bridging radiotherapy (BRT) is used for extra-cranial lymphoma where it can improve CAR T outcomes through cytoreduction of high-risk lesions. We hypothesized that BRT would achieve similar, significant cytoreduction prior to CAR T for CNSL (CNS-BRT). We identified CNSL patients with non-Hodgkin B-cell lymphoma who received CNS-BRT prior to commercial CAR T. Cytoreduction from CNS-BRT was calculated as change in lesion size prior to CAR T. Twelve patients received CNS-BRT, and the median follow up among survivors is 11.8 months (IQR: 8.5 - 21.9). Ten patients had CNSL (9 secondary, 1 primary) and 2 patients had epidural disease (evaluable for toxicity). All ten patients with CNSL had progressive disease at the time of CNS-BRT. 1/12 patients experienced grade ≥ 3 cytokine release syndrome (CRS), and 3/12 patients experienced grade ≥ 3 immune effector cell-associated neurotoxicity syndrome (ICANS). CNS-BRT achieved a 74.0% (95% confidence interval: 62.0 - 86.0) mean reduction in lesion size from baseline (p = 0.014) at a median of 12 days from BRT completion and prior to CAR T infusion. Best CNS response included 8 complete responses (CR), 1 partial response (PR), and 1 progressive disease (PD). Three patients experienced CNS relapse outside the BRT field. Preliminary data suggest CNS-BRT achieves rapid cytoreduction and is associated with a favorable CNS response and safety profile. These data support further study of BRT as a bridging modality for CNSL CAR T.

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Radiation therapy as bridging and salvage strategy among patients with secondary central nervous system lymphoma undergoing CD19‐targeted chimeric antigen receptor T‐cell therapy

Cited by 2 publications

References 22 publications

The contemporary spectrum of radiotherapy for hematologic malignancies involving the central nervous system: From focal therapy to craniospinal

The contemporary spectrum of radiotherapy for hematologic malignancies involving the central nervous system: From focal therapy to craniospinal

CNS bridging radiotherapy achieves rapid cytoreduction before CAR T-cell therapy for aggressive B-cell lymphomas

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