Department of Haematology, King's College Hospital, London, UK.
Department of Haematology, University College London Hospitals, London, UK.
Br J Haematol. 2024 Feb;204(2):507-513. doi: 10.1111/bjh.19157. Epub 2023 Oct 17.
The success of CD19 Chimeric antigen receptor (CAR) T-cell therapy in large B-cell lymphoma (LBCL) has been partially offset by toxicity and logistical challenges, which off-the-shelf agents like CD20xCD3 bispecific antibodies might potentially overcome. However, when using CAR T outcomes as the 'standard-of-care comparator̕ for relapsed/refractory (r/r) LBCL, a potential learning curve with implementing a novel, complex therapy like CAR T needs to be considered. To address this, we analysed 726 UK patients intended to be treated with CD19 CAR T for r/r LBCL and compared outcomes between the first year of the national CAR T programme (Era 1; 2019) and the more recent treatment era (Era 2; 2020-2022). We identified significant improvements for Era 2 versus Era 1 in dropout rate (17% vs. 27%, p = 0.001), progression-free survival (1-year PFS 50% vs. 32%, p < 0.001) and overall survival (1-year OS 60% vs. 40%, p < 0.001). We also observed increased use of bridging therapy, improvement in bridging outcomes, more tocilizumab/corticosteroid use, reduced high-grade cytokine release syndrome (4% vs. 9%, p = 0.01) and intensive care unit admissions (20% vs. 32%, p = 0.001). Our results demonstrate significant improvement in CAR T outcomes over time, highlighting the importance of using up-to-date clinical data when comparing CAR T against new treatment options for r/r LBCL.
嵌合抗原受体 (CAR) T 细胞疗法在大 B 细胞淋巴瘤 (LBCL) 中的成功部分被毒性和后勤挑战所抵消，而现成的药物，如 CD20xCD3 双特异性抗体，可能潜在地克服这些挑战。然而，当使用 CAR T 结果作为复发/难治性 (r/r) LBCL 的“标准护理对照”时，需要考虑实施新的、复杂的治疗方法（如 CAR T）的潜在学习曲线。为了解决这个问题，我们分析了 726 名计划接受 CD19 CAR T 治疗 r/r LBCL 的英国患者，并比较了国家 CAR T 计划的第一年（Era 1；2019 年）和最近的治疗时代（Era 2；2020-2022 年）的结果。我们发现 Era 2 与 Era 1 相比，脱落率（17%比 27%，p=0.001）、无进展生存期（1 年 PFS 50%比 32%，p<0.001）和总生存期（1 年 OS 60%比 40%，p<0.001）均有显著改善。我们还观察到桥接治疗的应用增加，桥接结果的改善，托珠单抗/皮质类固醇的使用增加，高级别细胞因子释放综合征（4%比 9%，p=0.01）和重症监护病房入院率（20%比 32%，p=0.001）降低。我们的结果表明 CAR T 结果随时间显著改善，强调了当比较 CAR T 与 r/r LBCL 的新治疗方案时，使用最新临床数据的重要性。
