Outcomes of Bridging Therapy in Patients With Relapsed/Refractory Large B Cell Lymphoma Receiving Third-Line CAR T

Area of Science:

• Hematology
• Oncology
• Immunotherapy

Background:

• Chimeric antigen receptor T cell (CAR T) therapy is a key treatment for relapsed/refractory large B-cell lymphoma (R/R LBCL).
• Bridging therapy (BT) is often administered before CAR T infusion, but optimal strategies are not well-defined.
• Evaluating different BT modalities is crucial for improving patient outcomes.

Purpose of the Study:

• To assess the impact of various bridging therapy (BT) strategies on response and survival in patients with R/R LBCL undergoing CAR T therapy.
• To compare the efficacy of chemotherapy, polatuzumab-based chemotherapy, radiotherapy, corticosteroids, and no BT.

Main Methods:

• Retrospective analysis of 219 patients with R/R LBCL undergoing third-line or later CD19-directed CAR T therapy.
• Comparison of BT modalities including chemotherapy, polatuzumab-based chemotherapy, radiotherapy, corticosteroids, and no BT.
• Assessment of overall response rate (ORR), progression-free survival (PFS), and overall survival (OS) using logistic regression and Cox models.

Main Results:

• Polatuzumab-based BT (50%) and radiotherapy (40%) showed higher ORR compared to chemotherapy (16%).
• Radiotherapy encompassing all active disease demonstrated a higher ORR (51%) versus non-comprehensive (12%).
• Two-year PFS was highest with radiotherapy (47%) and polatuzumab (37%) BT, while chemotherapy BT was associated with the highest 2-year lymphoma-related mortality (74%).

Conclusions:

• Polatuzumab-based and radiotherapy BT, as well as no BT, were associated with improved responses and outcomes compared to traditional chemotherapy.
• Radiotherapy and polatuzumab-based BT show promise in improving PFS and OS.
• Further prospective studies are needed to establish optimal, individualized BT strategies for R/R LBCL patients receiving CAR T therapy.