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Comparison of Survival Outcomes Between Chimeric Antigen Receptor T-Cell Therapy Recipients With and Without Central
Kenta Hayashino1, Nobuharu Fujii2, Satsuki Murakami3
1Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan; Department of Hematology, Oncology and Respiratory Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan.
Background:
Large B-cell lymphoma (LBCL) with central nervous system (CNS) involvement has a poor prognosis, primarily because of the high risk of relapse. Chimeric antigen receptor (CAR) T-cell therapy is a curative treatment for relapsed and/or refractory (r/r) LBCL. However, available data on the efficacy and safety of CAR T-cell therapy in patients with r/r LBCL with CNS involvement are limited.
Materials And Methods:
This retrospective study included patients with r/r LBCL who underwent CAR T-cell therapy at our institution between 2019 and 2024. The study endpoints were efficacy and safety in patients with and without a history of CNS involvement.
Results:
In total, 78 patients underwent CAR T-cell therapy during the observation period, and 10 patients had a history of CNS involvement. Three patients had primary CNS lymphoma, and 7 patients had secondary CNS lymphoma. Although the overall response rate and safety profile were similar between the 2 groups, 9 of the 10 patients experienced relapse, and the CNS group exhibited significantly worse progression-free survival (PFS) than the non-CNS group (median progression-free survival (PFS), 2.2 vs. not reached months; P = .0013). All patients with primary CNS lymphoma received tirabrutinib after failure of CAR T-cell therapy and achieved an objective response, without severe complications. In contrast, none of the patients with secondary CNS lymphoma achieved remission.
Conclusion:
CNS involvement was significantly associated with poor prognosis, highlighting the need for further strategies, such as tirabrutinib, to improve outcomes in this population.
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