The International Prognostic Index Is Associated with Outcomes in Diffuse Large B Cell Lymphoma after Chimeric Antigen Receptor T Cell Therapy

Marta Garcia-Recio, Kitsada Wudhikarn, Martina Pennisi, Rosalia Alonso-Trillo, Jessica Flynn, Roni Shouval, Aishat O. Afuye, Mari Lynne Silverberg, Connie W. Batlevi, Parastoo Dahi, Sean Devlin, Sergio A. Giralt, Elizabeth Halton, Josel Ruiz, Molly Maloy, Elena Mead, M. Lia Palomba, Bianca Santomasso, Craig S. Sauter, Michael ScordoGunjan L. Shah, Miguel Angel Perales*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

CD19-targeted chimeric antigen receptor (CAR) T cells have shown excellent activity against relapsed and refractory (R/R) diffuse large B cell lymphoma (DLBCL). CAR T cell therapy is associated with early toxicities, including cytokine release syndrome and neurotoxicity. The incidence and severity of these toxicities has been associated in part with baseline disease and patient characteristics, which also may impact overall survival (OS) and progression-free survival (PFS). However, there are limited data on patient selection and how to better predict toxicities or outcomes. Indexes used in patients with DLBCL, such as the International Prognostic Index (IPI and age-adjusted IPI [aaIPI]) and in transplantation recipients, such as the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI), have not been evaluated in this setting. Here we evaluated 4 indices— IPI, aaIPI, HCT-CI, and the Charlson Comorbidity Index (CCI)—and their associations with early CAR T cell related-toxicities and outcomes. We demonstrated an association between high-risk IPI or aaIPI and inferior PFS in patients with R/R DLBCL treated with CAR T cell therapy. We also found an association between aaIPI and IPI with OS and neurotoxicity, respectively. CCI was not associated with toxicities or outcomes, and owing to the small sample size, we could not draw a conclusion regarding associations with the HCT-CI. Both the IPI and aaIPI are widely used tools that can now provide better information to guide selection of patients who would best benefit from CD19 CAR T cell therapy.

Original languageEnglish
Pages (from-to)233-240
Number of pages8
JournalTransplantation and Cellular Therapy
Volume27
Issue number3
DOIs
StatePublished - Mar 2021
Externally publishedYes

Funding

FundersFunder number
Associazione italiana contro le leucemie-linfomi e mieloma Milano e Provincia ONLUS
CIBMTR Cellular Immunotherapy Data Resource Committee
GLG
McKinsey & Company and Angiocrine Bioscience
National Cancer Institute Cancer Center Support
National Institutes of Health
National Cancer InstituteP30CA008748
AMGEN
Bristol-Myers Squibb
Astellas Pharma US
Merck
Novartis
American-Italian Cancer Foundation
AbbVie
Janssen Pharmaceuticals
Parker Institute for Cancer Immunotherapy
Bayer Fund
American Society for Transplantation and Cellular Therapy
Miltenyi Biotec

    Keywords

    • Cellular therapy
    • Chimeric antigen receptor T cells
    • International Prognostic Index
    • Non-Hodgkin lymphoma

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