Yegya-Raman Nikhil, Wright Christopher M, LaRiviere Michael J, Baron Jonathan A, Lee Daniel Y, Landsburg Daniel J, Svoboda Jakub, Nasta Sunita D, Gerson James N, Barta Stefan K, Chong Elise A, Schuster Stephen J, Maity Amit, Facciabene Andrea, Paydar Ima, Plastaras John P
Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States.
Department of Medicine, Hematology/Oncology Division, University of Pennsylvania, Philadelphia, PA, United States.
Clin Transl Radiat Oncol. 2023 Jan 20;39:100587. doi: 10.1016/j.ctro.2023.100587. eCollection 2023 Mar.
CD19-targeting chimeric antigen receptor T-cell (CART) therapy is a promising treatment for relapsed/refractory non-Hodgkin lymphoma, but most patients experience post-CART progression. We describe our institutional experience of salvage radiotherapy (SRT) in this setting.
Of 94 patients who received CART therapy from 2018 to 2020, 21 received SRT for post-CART progression. Patients were divided into two groups: locoregional disease (n = 9 [43 %], all disease encompassable within an RT field) and advanced disease (n = 12 [57 %]). Patterns of failure, progression-free survival (PFS), overall survival (OS), and toxicity were assessed.
Median time from CART infusion to SRT was 4.0 months (range, 0.6-11.5 months). In the locoregional disease group, 8/9 patients (89 %) were treated with comprehensive SRT to a median dose of 37.5 Gy in a median of 15 fractions. In the advanced disease group, all patients (n = 12) were treated with focal SRT to a median dose of 20.8 Gy in a median of 5 fractions. Median follow-up post-SRT was 15.2 months. In-field response was observed in 8/9 (89 %) in the locoregional disease and 8/9 (89 %) evaluable patients in the advanced disease groups. 17/18 evaluable patients (94 %) patients experienced post-SRT progression, all with a distant component. Median OS was 7.4 months; 21 months for locoregional disease versus 2.4 months for advanced disease (p = 0.0002). Median PFS was 1.1 month, and similarly poor regardless of group. No grade ≥ 3 toxicities occurred.
SRT post-CART therapy appears safe with encouraging in-field response but high rates of out-of-field progression, even for those presenting with locoregional disease, highlighting the need for integration of novel systemic agents.
靶向CD19的嵌合抗原受体T细胞（CART）疗法是复发/难治性非霍奇金淋巴瘤的一种有前景的治疗方法，但大多数患者在接受CART治疗后会出现病情进展。我们描述了我们机构在这种情况下进行挽救性放疗（SRT）的经验。
在2018年至2020年接受CART治疗的94例患者中，21例因CART治疗后病情进展接受了SRT。患者分为两组：局部区域疾病组（n = 9 [43%]，所有疾病均可纳入放疗野内）和晚期疾病组（n = 12 [57%]）。评估了失败模式、无进展生存期（PFS）、总生存期（OS）和毒性。
从CART输注到SRT的中位时间为4.0个月（范围0.6 - 11.5个月）。在局部区域疾病组中，8/9例患者（89%）接受了综合SRT，中位剂量为37.5 Gy，中位分割次数为15次。在晚期疾病组中，所有患者（n = 12）接受了局部SRT，中位剂量为20.8 Gy，中位分割次数为5次。SRT后的中位随访时间为15.2个月。局部区域疾病组8/9例（89%）和晚期疾病组8/9例可评估患者（89%）观察到野内缓解。17/18例可评估患者（94%）在SRT后出现病情进展，均有远处转移成分。中位OS为7.4个月；局部区域疾病组为21个月，晚期疾病组为2.4个月（p = 0.0002）。中位PFS为1.1个月，无论哪一组情况都同样较差。未发生≥3级毒性反应。
CART治疗后进行SRT似乎是安全的，野内缓解令人鼓舞，但野外进展率较高，即使是那些表现为局部区域疾病的患者也是如此，这突出了联合新型全身治疗药物的必要性。
