TY - JOUR
T1 - The International Prognostic Index Is Associated with Outcomes in Diffuse Large B Cell Lymphoma after Chimeric Antigen Receptor T Cell Therapy
AU - Garcia-Recio, Marta
AU - Wudhikarn, Kitsada
AU - Pennisi, Martina
AU - Alonso-Trillo, Rosalia
AU - Flynn, Jessica
AU - Shouval, Roni
AU - Afuye, Aishat O.
AU - Silverberg, Mari Lynne
AU - Batlevi, Connie W.
AU - Dahi, Parastoo
AU - Devlin, Sean
AU - Giralt, Sergio A.
AU - Halton, Elizabeth
AU - Ruiz, Josel
AU - Maloy, Molly
AU - Mead, Elena
AU - Palomba, M. Lia
AU - Santomasso, Bianca
AU - Sauter, Craig S.
AU - Scordo, Michael
AU - Shah, Gunjan L.
AU - Perales, Miguel Angel
N1 - Publisher Copyright:
© 2020 The American Society for Transplantation and Cellular Therapy
PY - 2021/3
Y1 - 2021/3
N2 - 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.
AB - 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.
KW - Cellular therapy
KW - Chimeric antigen receptor T cells
KW - International Prognostic Index
KW - Non-Hodgkin lymphoma
UR - http://www.scopus.com/inward/record.url?scp=85101145531&partnerID=8YFLogxK
U2 - 10.1016/j.jtct.2020.10.022
DO - 10.1016/j.jtct.2020.10.022
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C2 - 33781518
AN - SCOPUS:85101145531
SN - 2666-6367
VL - 27
SP - 233
EP - 240
JO - Transplantation and Cellular Therapy
JF - Transplantation and Cellular Therapy
IS - 3
ER -