Effect of Delayed Cell Infusion in Patients With Large B-Cell Lymphoma Treated With Chimeric Antigen Receptor T-Cell Therapy

Authors

Andrew P Jallouk
Naishu Kui
Ryan Sun
Jason R Westin
Raphael E Steiner
Ranjit Nair
Loretta J Nastoupil
Luis E Fayad
Ajlan Al Zaki
Misha Hawkins
Sherry Adkins
Mansoor Noorani
Kaberi Das
Jared Henderson
Elizabeth J Shpall
Partow Kebriaei
Jeremy Ramdial
Christopher R Flowers
Sattva S Neelapu
Sairah Ahmed
Paolo Strati

Publication Date

5-1-2024

Journal

Haematologica

Abstract

Complications occurring after lymphodepleting chemotherapy (LDC) may delay chimeric antigen receptor (CAR) T-cell infusion. The effect of these delays on clinical outcomes is unclear. We performed a retrospective analysis of 240 patients with relapsed/refractory large B-cell lymphoma treated with standard-of-care axicabtagene ciloleucel (axi-cel) and identified 40 patients (16.7%) who had delay in axi-cel infusion. Of these, 85% had delay due to infection. At time of LDC initiation, patients with delayed infusion had lower absolute neutrophil count (P=0.006), lower platelets (P=0.004), lower hemoglobin (P5 days (4.6 vs. 8.2 months; P=0.036), but not 1 day (5.7 vs. 8.2 months; P=0.238). Following propensity score matching, patients with delayed infusion continued to have shorter median PFS (3.5 vs. 6.0 months; P=0.015). Levels of pro-inflammatory cytokines on day of infusion were significantly higher in patients with delayed infusion. Together, these findings suggest that delays in CAR T-cell administration after initiation of LDC are associated with inferior outcomes. Further studies are needed to guide strategies to improve efficacy in such patients.

Keywords

Treatment Delay, Lymphoma, B-Cell, Immunotherapy, Adoptive, Humans, Male, Female, Adolescent, Young Adult, Adult, Middle Aged, Aged, Aged, 80 and over, Progression-Free Survival, Lymphocyte Depletion

Comments

Supplementary Materials

Data Availability Statement

PMID: 38031807