Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
Department of Pharmacy, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
J Clin Exp Hematop. 2024;64(2):107-118. doi: 10.3960/jslrt.24009.
Patients with refractory or relapsed (R/R) large B-cell lymphoma (LBCL) refractory to first-line chemotherapy or with early relapse have poor outcomes. While chimeric antigen receptor (CAR) T-cell therapy has impressive efficacy after two or more lines of chemotherapy, it's still uncertain if these outcomes remain consistent in the context of third-line CAR T-cell therapy. We conducted a retrospective study of 107 R/R LBCL patients. Patients with relapse 12 months or more after their first-line chemoimmunotherapy (late failure: n = 25) had significantly longer overall survival (OS) than patients with refractory disease or relapse within 12 months (early failure: n = 82) (median OS: not achieved vs. 18.4 months; P < 0.001). Among patients who proceeded to autologous hematopoietic stem-cell transplantation (auto-HSCT), those with late failure had significantly longer event-free survival (EFS) than those with early failure (median EFS: 26.9 vs. 3.1 months; P = 0.012). However, no significant difference in EFS was detected among patients who underwent CAR T-cell therapy (median EFS: not reached vs. 11.8; P = 0.091). Cox regression with restricted cubic spline demonstrated that timing of relapse had significant impact on EFS in patients with auto-HSCT but not in patients with CAR T-cell therapy. Of patients who were scheduled for CAR T-cell therapy, those with late failure were significantly more likely to receive CAR T-cell therapy than those with early failure (90% vs. 57%; P = 0.008). In conclusion, patients with early failure still experienced poor outcomes after the approval of third-line CAR T-cell therapy.
对于一线化疗耐药或早期复发的难治性或复发（R/R）大 B 细胞淋巴瘤（LBCL）患者，预后较差。尽管嵌合抗原受体（CAR）T 细胞疗法在二线或以上化疗后具有显著疗效，但在三线 CAR T 细胞疗法的背景下，这些结果是否仍然一致仍不确定。我们对 107 例 R/R LBCL 患者进行了回顾性研究。一线化疗免疫治疗后 12 个月或以上复发的患者（晚期失败：n = 25）的总生存期（OS）明显长于疾病耐药或 12 个月内复发的患者（早期失败：n = 82）（中位 OS：未达到 vs. 18.4 个月；P < 0.001）。在接受自体造血干细胞移植（auto-HSCT）的患者中，晚期失败患者的无事件生存期（EFS）明显长于早期失败患者（中位 EFS：26.9 个月 vs. 3.1 个月；P = 0.012）。然而，在接受 CAR T 细胞治疗的患者中，EFS 无显著差异（中位 EFS：未达到 vs. 11.8 个月；P = 0.091）。用受限立方样条 Cox 回归分析显示，在接受 auto-HSCT 的患者中，复发时间对 EFS 有显著影响，但在接受 CAR T 细胞治疗的患者中无显著影响。在计划接受 CAR T 细胞治疗的患者中，晚期失败患者比早期失败患者更有可能接受 CAR T 细胞治疗（90% vs. 57%；P = 0.008）。总之，三线 CAR T 细胞治疗批准后，早期失败患者的预后仍较差。
