Comparison of Survival Outcomes Between Chimeric Antigen Receptor T-Cell Therapy Recipients With and Without Central Nervous System Involvement.

BACKGROUND

Large B-cell lymphoma (LBCL) with central nervous system (CNS) involvement has a poor prognosis, primarily because of the high risk of relapse. Chimeric antigen receptor (CAR) T-cell therapy is a curative treatment for relapsed and/or refractory (r/r) LBCL. However, available data on the efficacy and safety of CAR T-cell therapy in patients with r/r LBCL with CNS involvement are limited.

MATERIALS AND METHODS

This retrospective study included patients with r/r LBCL who underwent CAR T-cell therapy at our institution between 2019 and 2024. The study endpoints were efficacy and safety in patients with and without a history of CNS involvement.

RESULTS

In total, 78 patients underwent CAR T-cell therapy during the observation period, and 10 patients had a history of CNS involvement. Three patients had primary CNS lymphoma, and 7 patients had secondary CNS lymphoma. Although the overall response rate and safety profile were similar between the 2 groups, 9 of the 10 patients experienced relapse, and the CNS group exhibited significantly worse progression-free survival (PFS) than the non-CNS group (median progression-free survival (PFS), 2.2 vs. not reached months; P = .0013). All patients with primary CNS lymphoma received tirabrutinib after failure of CAR T-cell therapy and achieved an objective response, without severe complications. In contrast, none of the patients with secondary CNS lymphoma achieved remission.

CONCLUSION

CNS involvement was significantly associated with poor prognosis, highlighting the need for further strategies, such as tirabrutinib, to improve outcomes in this population.