CAR T-cell therapy for secondary CNS DLBCL

Area of Science:

• Hematology
• Oncology
• Neuro-oncology

Background:

• Secondary central nervous system involvement in aggressive B-cell lymphomas (SCNSL) presents a significant unmet medical need.
• Current treatment options for relapsed or refractory SCNSL are limited, necessitating novel therapeutic approaches.

Purpose of the Study:

• To evaluate the safety and efficacy of chimeric antigen receptor (CAR) T-cell therapy in adult patients with relapsed or refractory SCNSL.
• To assess the safety of whole brain radiation therapy (WBRT) as a bridging strategy prior to CAR T-cell therapy in SCNSL patients, specifically regarding immune effector cell-associated neurotoxicity syndrome (ICANS).

Main Methods:

• A single-center retrospective analysis was conducted on 7 adult patients with SCNSL who received CAR T-cell therapy.
• Data on treatment response, progression-free survival (PFS), overall survival (OS), and ICANS incidence were collected and analyzed.
• A subset of patients received WBRT as bridging therapy before CAR T-cell infusion.

Main Results:

• Six out of seven patients (85.7%) achieved a complete response at day 28 post-CAR T-cell therapy.
• Median progression-free survival was 83 days, and median overall survival was 129 days.
• Among 5 patients who received WBRT bridging therapy, 3 experienced no ICANS, and 2 had grade 1 or 3 ICANS; no grade 4 ICANS was observed.

Conclusions:

• SCNSL should not be a contraindication for CAR T-cell therapy due to concerns about ICANS.
• Bridging therapy with WBRT in SCNSL patients undergoing CAR T-cell therapy is not associated with an increased risk of ICANS.