Axicabtagene Ciloleucel in Patients Ineligible for ZUMA-1 Because of CNS Involvement and/or HIV: A Multicenter...

Area of Science:

• Oncology
• Immunotherapy
• Hematology

Background:

• Secondary central nervous system lymphoma (SCNSL) presents a significant clinical challenge with a poor prognosis.
• Existing therapeutic options for SCNSL are limited, necessitating the exploration of novel treatment strategies.
• The pivotal ZUMA-1 trial, leading to FDA approval of axicabtagene ciloleucel, excluded patients with SCNSL and human immunodeficiency virus (HIV).

Purpose of the Study:

• To evaluate the efficacy and safety of axicabtagene ciloleucel in patients with SCNSL.
• To assess the outcomes of chimeric antigen receptor T-cell therapy in a cohort of SCNSL patients, including those with HIV co-infection.

Main Methods:

• A multi-institutional retrospective study was conducted.
• Fourteen patients diagnosed with SCNSL were treated with axicabtagene ciloleucel.
• Outcomes, including rates of severe neurotoxicity and complete response, were analyzed.

Main Results:

• The study observed a severe neurotoxicity rate of 32% and a complete response rate of 58% in SCNSL patients treated with axicabtagene ciloleucel.
• Three patients in the cohort had human immunodeficiency virus (HIV) and were included in the analysis.
• These response and toxicity rates were comparable to those reported in the ZUMA-1 trial at a median follow-up of 5.9 months.

Conclusions:

• Chimeric antigen receptor T-cell therapy, specifically axicabtagene ciloleucel, demonstrates potential as a life-saving treatment for patients with SCNSL.
• The therapy should not be withheld from SCNSL patients, even those with HIV co-infection, given the promising outcomes.
• Further prospective studies are warranted to confirm these findings in larger cohorts.