All content on this site is intended for healthcare professionals only. By acknowledging this message and accessing the information on this website you are confirming that you are a Healthcare Professional. If you are a patient or carer, please visit the Lymphoma Coalition.
The lym Hub website uses a third-party service provided by Google that dynamically translates web content. Translations are machine generated, so may not be an exact or complete translation, and the lym Hub cannot guarantee the accuracy of translated content. The lym and its employees will not be liable for any direct, indirect, or consequential damages (even if foreseeable) resulting from use of the Google Translate feature. For further support with Google Translate, visit Google Translate Help.
The Lymphoma & CLL Hub is an independent medical education platform, sponsored by AbbVie, BeOne Medicines, Johnson & Johnson, Roche, and Sobi, and supported through educational grants from Bristol Myers Squibb, Incyte, Lilly, and Pfizer. View funders.
Now you can support HCPs in making informed decisions for their patients
Your contribution helps us continuously deliver expertly curated content to HCPs worldwide. You will also have the opportunity to make a content suggestion for consideration and receive updates on the impact contributions are making to our content.
Find out moreCreate an account and access these new features:
Bookmark content to read later
Select your specific areas of interest
View lym content recommended for you
Chimeric antigen receptor (CAR) T-cell therapy is under investigation for the treatment of several hematological malignancies. Currently, the only United States (U.S.) Food & Drug Administration (FDA) and European Medicines Agency (EMA) approved indications for CAR T are diffuse large B-cell lymphoma (DLBCL) and acute lymphoblastic leukemia (ALL). Many of the CAR constructs being investigated in clinical trials for the treatment of B-cell malignancies target CD19.1-4 However, malignant B cells have developed mechanisms to evade immunotherapies that target specific antigens such as CD19. These include mutation, alternative splicing, protein misfolding of CD19 or myeloid lineage switch of CD19-positive malignant cells. Antigen escape can lead to relapse following CD19-targeted therapies and these patients have poor outcomes.
One proposed method of reducing antigen escape, and subsequently lowering relapse rates, is to infuse two single-specific CAR T products against different antigens. Na Wang, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, CH, and colleagues, therefore conducted a pilot study (ChiCTR-OPN-16008526), in 89 patients with relapsed/refractory (R/R) B-cell malignancies, using two CAR T products administered sequentially.5
The Lymphoma Hub previously covered CAR T therapy as an educational theme. Read more here.
Reported here only in patients with NHL. To read the results in ALL, please refer to the original paper.
In patients with NHL who were evaluable for efficacy (n= 36), with a minimum follow-up of three months, 18 patients had achieved complete responses (CR), with eight more achieving a partial response (PR), giving an overall response rate (ORR) of 72.2% (Table 1). The ORR was consistent across subgroups when analyzed by pathologic subtype or cytogenetic risk.
Table 1. Efficacy of CAR T infusions in patients with B-cell NHL, and sub-analysis in patients with diffuse large B-cell lymphoma (DLBCL)* Median follow-up of 14.4 months (range 0.4–27.4) in patients with B-cell NHL, and 14.3 months (0.4–27.3) in patients with DLBCL
Patients with B-cell NHL
(n= 36)
95% CI
Patients with DLBCL
(n=23)
95% CI
ORR
72.2%
54.8–85.8
-
-
CR
50.0%
32.9–67.1
-
-
PR
22.2%
10.1–39.2
-
-
Median progression-free survival (PFS)*
9.9 months
3.3–not reached (NR)
5.8 months
3.0–NR
Twelve-month PFS
50.0%
33.4–64.5
47.8%
26.8–66.1
Median overall survival (OS)*
18.0 months
6.1–NR
18.0 months
5.2–NR
Twelve-month OS
55.3%
38.3–69.3
-
-
For total cohort (patients with B-ALL and B-cell NHL)
N=89
Grade 3, %
Grade 4, %
Grade 5, %
Lymphocytopenia
0
100
0
Neutrocytopenia
2
98
0
Leukopenia
7
92
0
Anemia
72
10
0
CRS
17
3
1
Fever
36
0
0
Thrombocytopenia
11
52
0
Hypotension
9
0
0
Activated partial thromboplastin time prolonged
6
0
0
Hypokalemia
13
3
0
Diarrhea
6
0
0
Aspartate aminotransferase increase
7
0
0
Lung infection
18
0
3
The sequential infusion of two separate CAR T products, each targeting a different B-cell antigen, has shown robust responses with a reduction in antigen escape in patients with R/R B-ALL and B-cell NHL.
In patients with B-cell NHL, the survival advantage was most apparent in patients who achieved an overall response at three months, indicating R3M may be a good predictor of survival in this population. This approach was also most beneficial at first relapse, indicating a potential role as a second-line treatment for patients with R/R B-cell NHL.
However, superior long-term survival was not observed following this dual-targeted approach, with comparable efficacy to single-specific CAR T-cells. The authors suggest efforts are focused on sustaining CAR T persistence in vivo to enable CAR T to become definitive, as opposed to bridging, therapy.
References
Please indicate your level of agreement with the following statements:
The content was clear and easy to understand
The content addressed the learning objectives
The content was relevant to my practice
I will change my clinical practice as a result of this content
Your opinion matters
Which of the following would most increase your confidence in referring patients with R/R large B-cell lymphoma for CAR T-cell therapy?