Effectiveness of anti-CD19 CAR T-cell therapy for high-grade B-cell lymphoma in Japan: a single-institution analysis

While clinical data on anti-CD19 chimeric antigen receptor (CAR) T-cell therapy in relapsed/refractory (R/R) large B-cell lymphoma (LBCL) have been established, data specifically focusing on high-grade B-cell lymphoma (HGBCL) remain limited.

To evaluate the efficacy of CAR T-cell therapy for HGBCL, we conducted a single-center retrospective study of patients with R/R HGBCL who received CAR T-cell therapy at our institution between March 2022 and October 2024.

This study included 15 patients with R/R HGBCL treated with CAR T-cell therapy (10 with axicabtagene ciloleucel and 5 with lisocabtagene maraleucel). The median age at CAR T-cell infusion was 62 years (range, 39-76 years). Eleven patients (73.3%) were refractory to first-line therapy and 11 (73.3%) had MYC and BCL2 rearrangements. High-grade morphology was observed in nine patients (60.0%). Nine patients (60.0%) received CAR T-cell therapy as second-line treatment. The best overall response rate was 80.0%, with a complete response rate of 66.7%. At a median follow-up of 18.5 months (range, 1.3-26.0 months), the 1-year progression-free survival (PFS) rate was 40.0%. In univariate analysis, high-grade morphology was associated with inferior PFS (HR 5.09; 95% CI 1.46-17.73, p = 0.019), whereas high lactate dehydrogenase level and high metabolic tumor volume at lymphodepletion, number of prior lines of chemotherapy and MYC and BCL2 rearrangements were not significantly associated with PFS.

The efficacy of CAR T-cell therapy in patients with R/R HGBCL remains suboptimal. High-grade morphology may help identify patients at particularly high risk of poor outcomes following CAR T-cell therapy.