Allogeneic transplant following CAR T-cell therapy for large B-cell lymphoma

Haematologica. 2023 Jan 1;108(1):98-109. doi: 10.3324/haematol.2022.281242.

Abstract

Allogeneic hematopoietic cell transplantation (alloHCT) can potentially salvage large B-cell lymphoma (LBCL) patients experiencing treatment failure after chimeric antigen receptor T-cell therapy (CAR T). Nonetheless, data on the efficacy and toxicities of alloHCT after receipt of CAR T are limited. We report a multicenter retrospective study assessing the safety, toxicities, and outcomes of alloHCT in LBCL patients following CAR T failure. Eighty-eight patients with relapsed, refractory LBCL received an alloHCT following anti-CD19 CAR T failure. The median number of lines of therapy between CAR T infusion and alloHCT was one (range, 0-7). Low intensity conditioning was used in 77% (n=68) and peripheral blood was the most common graft source (86%, n=76). The most common donor types were matched unrelated donor (39%), followed by haploidentical (30%) and matched related donor (26%). Median follow-up of survivors was 15 months (range, 1-72). One-year overall survival, progression-free survival, and graft-versus-host disease-free relapse-free survival were 59%, 45%, and 39% respectively. One-year non-relapse mortality and progression/relapse were 22% and 33% respectively. On multivariate analysis, <2 lines of intervening therapy between CAR T and alloHCT and complete response at time of alloHCT were associated with better outcomes. In conclusion, alloHCT after CAR T failure can provide durable remissions in a subset of patients.

Publication types

  • Multicenter Study

MeSH terms

  • Antigens, CD19
  • Hematopoietic Stem Cell Transplantation* / adverse effects
  • Humans
  • Immunotherapy, Adoptive / adverse effects
  • Lymphoma, Large B-Cell, Diffuse* / etiology
  • Lymphoma, Large B-Cell, Diffuse* / therapy
  • Neoplasm Recurrence, Local / etiology
  • Receptors, Chimeric Antigen*
  • Retrospective Studies
  • Transplantation, Homologous

Substances

  • Receptors, Chimeric Antigen
  • Antigens, CD19