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Lemoine J, Bachy E, Cartron G, Beauvais D, Gastinne T, Di Blasi R, Rubio MT, Guidez S, Mohty M, Casasnovas RO, Joris M, Castilla-Llorente C, Haioun C, Hermine O, Loschi M, Carras S, Bories P, Fradon T, Herbaux C, Sesques P, Le Gouill S, Morschhauser F, Thieblemont C, Houot R. Nonrelapse mortality after CAR T-cell therapy for large B-cell lymphoma: a LYSA study from the DESCAR-T registry. Blood Adv 2023; 7:6589-6598. [PMID: 37672383 PMCID: PMC10641092 DOI: 10.1182/bloodadvances.2023010624] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 09/08/2023] Open
Abstract
CD19 chimeric antigen receptor (CAR) T cells can induce prolonged remissions and potentially cure a significant proportion of patients with relapsed/refractory large B-cell lymphomas. However, some patients may die of causes unrelated to lymphoma after CAR T-cell therapy. To date, little is known about the nonrelapse mortality (NRM) after CAR T-cell therapy. Using the French DESCAR-T registry, we analyzed the incidence and causes of NRM and identified risk factors of NRM. We report on 957 patients who received standard-of-care axicabtagene ciloleucel (n = 598) or tisagenlecleucel (n = 359) between July 2018 and April 2022, in 27 French centers. With a median follow-up of 12.4 months, overall NRM occurred in 48 patients (5.0% of all patients): early (before day 28 after infusion) in 9 patients (0.9% of all patients and 19% of overall NRM), and late (on/after day 28 after infusion) in 39 patients (4.1% of all patients and 81% of overall NRM). Causes of overall NRM were distributed as follows: 56% infections (29% with non-COVID-19 and 27% with COVID-19), 10% cytokine release syndromes, 6% stroke, 6% cerebral hemorrhage, 6% second malignancies, 4% immune effector cell associated neurotoxicities, and 10% deaths from other causes. We report risk factors of early NRM and overall NRM. In multivariate analysis, both diabetes and elevated ferritin level at lymphodepletion were associated with an increased risk of overall NRM. Our results may help physicians in patient selection and management in order to reduce the NRM after CAR T-cell therapy.
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Affiliation(s)
- Jean Lemoine
- Department of Hematology, CHU de Rennes, Rennes, France
| | - Emmanuel Bachy
- Department of Hematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Benite, France
| | | | | | | | - Roberta Di Blasi
- Department of Hemato-Oncology, Saint Louis Hospital, Paris, France
| | | | | | - Mohamad Mohty
- Department of Hematology, Saint Antoine Hospital, Paris, France
| | | | - Magalie Joris
- Department of Hematology, CHU d’Amiens, Amiens, France
| | - Cristina Castilla-Llorente
- Department of Hematology and INSERM, UMR 1030, Université Paris-Saclay, Gustave Roussy Cancer Campus Grand Paris, Paris, France
| | - Corinne Haioun
- Lymphoid Malignancies, Henri Mondor Hospital, Créteil, France
| | | | | | - Sylvain Carras
- Department of Hematology, CHU de Grenoble, Grenoble, France
| | - Pierre Bories
- Hematology Laboratory, Onco-occitanie Network, Toulouse University Institute of Cancer-Oncopole, Toulouse, France
| | - Tom Fradon
- LYSARC, The Lymphoma Academic Research Organisation, Lyon-Sud Hospital, Pierre-Benite, France
| | - Charles Herbaux
- Department of Hematology, CHU de Montpellier, Montpellier, France
| | - Pierre Sesques
- Department of Hematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Benite, France
| | | | | | | | - Roch Houot
- Department of Hematology, CHU de Rennes, Rennes, France
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Lipe DN, Qdaisat A, Chaftari P, Wattana MK, Krishnamani PP, Reyes-Gibby C, Yeung SCJ. Emergency department use by patients who received chimeric antigen receptor T cell infusion therapy. Front Oncol 2023; 13:1122329. [PMID: 37007139 PMCID: PMC10064130 DOI: 10.3389/fonc.2023.1122329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/08/2023] [Indexed: 03/19/2023] Open
Abstract
BackgroundChimeric antigen receptor T cell infusion (CAR T) therapy has revolutionized the treatment of hematologic malignancies, but treatment-related toxicities are of concern. Understanding the timing and reasons for which patients present to the emergency department (ED) after CAR T therapy can assist with the early recognition and management of toxicities.MethodsA retrospective observational cohort study was conducted for patients who had undergone CAR T therapy in the past 6 months and visited the ED of The University of Texas MD Anderson Cancer Center between 04/01/2018 and 08/01/2022. The timing of presentation after CAR T product infusion, patient characteristics, and outcomes of the ED visit were examined. Survival analyses were conducted using Cox proportional hazards regression and Kaplan-Meier estimates.ResultsDuring the period studied, there were 276 ED visits by 168 unique patients. Most patients had diffuse large B-cell lymphoma (103/168; 61.3%), multiple myeloma (21/168; 12.5%), or mantle cell lymphoma (16/168; 9.5%). Almost all 276 visits required urgent (60.5%) or emergent (37.7%) care, and 73.5% of visits led to admission to the hospital or observation unit. Fever was the most frequent presenting complaint, reported in 19.6% of the visits. The 30-day and 90-day mortality rates after the index ED visits were 17.0% and 32.2%, respectively. Patients who had their first ED visit >14 days after CAR T product infusion had significantly worse overall survival (multivariable hazard ratio 3.27; 95% confidence interval 1.29–8.27; P=0.012) than patients who first visited the ED within 14 days of CAR T product infusion.ConclusionCancer patients who receive CAR T therapy commonly visit the ED, and most are admitted and/or require urgent or emergent care. During early ED visits patients mainly present with constitutional symptoms such as fever and fatigue, and these early visits are associated with better overall survival.
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Affiliation(s)
- Demis N. Lipe
- Department of Medical Services, IQVIA Biotech, Houston, TX, United States
| | - Aiham Qdaisat
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Patrick Chaftari
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Monica K. Wattana
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Pavitra P. Krishnamani
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Cielito Reyes-Gibby
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sai-Ching J. Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- *Correspondence: Sai-Ching J. Yeung,
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Cheok KPL, Kirkwood AA, Menne T, Tholouli E, Chaganti S, Mathew A, Uttenthal B, Russell J, Irvine D, Johnson R, Nicholson E, Bazin J, Townsend W, Kuhnl A, O’Reilly M, Sanderson R, Patel A, Roddie C. Severe presentations and high mortality from SARS-CoV-2 in patients undergoing chimeric antigen receptor (CAR-T) therapy: a UK NCCP analysis. Leuk Lymphoma 2022; 63:1980-1984. [DOI: 10.1080/10428194.2022.2057487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kathleen P. L. Cheok
- Department of Hematology, University College London, London, UK
- Department of Hematology, University College London Hospital, London, UK
| | - Amy A. Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
| | - Tobias Menne
- Department of Hematology, Freeman Hospital, Newcastle, UK
| | - Eleni Tholouli
- Department of Hematology, Manchester Royal Infirmary, Manchester, UK
| | - Sridhar Chaganti
- Department of Hematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Amrith Mathew
- Department of Hematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Ben Uttenthal
- Department of Hematology, Addenbrooke’s Hospital, Cambridge, UK
| | - James Russell
- Department of Hematology, Addenbrooke’s Hospital, Cambridge, UK
| | - David Irvine
- Department of Hematology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Rod Johnson
- Department of Hematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Emma Nicholson
- Department of Hematology, Royal Marsden Hospital, London, UK
| | - Jessica Bazin
- Department of Hematology, Royal Marsden Hospital, London, UK
| | - William Townsend
- Department of Hematology, University College London Hospital, London, UK
| | - Andrea Kuhnl
- Department of Hematology, King’s College Hospital, London, UK
| | - Maeve O’Reilly
- Department of Hematology, University College London Hospital, London, UK
| | - Robin Sanderson
- Department of Hematology, King’s College Hospital, London, UK
| | - Amit Patel
- Department of Hematology, Christie Hospital, Manchester, UK
| | - Claire Roddie
- Department of Hematology, University College London, London, UK
- Department of Hematology, University College London Hospital, London, UK
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Murciano-Goroff YR, Warner AB, Wolchok JD. The future of cancer immunotherapy: microenvironment-targeting combinations. Cell Res 2020; 30:507-519. [PMID: 32467593 PMCID: PMC7264181 DOI: 10.1038/s41422-020-0337-2] [Citation(s) in RCA: 412] [Impact Index Per Article: 103.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/29/2020] [Indexed: 02/08/2023] Open
Abstract
Immunotherapy holds the potential to induce durable responses, but only a minority of patients currently respond. The etiologies of primary and secondary resistance to immunotherapy are multifaceted, deriving not only from tumor intrinsic factors, but also from the complex interplay between cancer and its microenvironment. In addressing frontiers in clinical immunotherapy, we describe two categories of approaches to the design of novel drugs and combination therapies: the first involves direct modification of the tumor, while the second indirectly enhances immunogenicity through alteration of the microenvironment. By systematically addressing the factors that mediate resistance, we are able to identify mechanistically-driven novel approaches to improve immunotherapy outcomes.
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Affiliation(s)
| | - Allison Betof Warner
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
- Weill Cornell Medicine, New York, NY, 10065, USA
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | - Jedd D Wolchok
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
- Weill Cornell Medicine, New York, NY, 10065, USA.
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA.
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Vitale C, Strati P. CAR T-Cell Therapy for B-Cell non-Hodgkin Lymphoma and Chronic Lymphocytic Leukemia: Clinical Trials and Real-World Experiences. Front Oncol 2020; 10:849. [PMID: 32670869 PMCID: PMC7326110 DOI: 10.3389/fonc.2020.00849] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/29/2020] [Indexed: 12/13/2022] Open
Abstract
Chimeric antigen receptor-modified (CAR) T cells targeting CD19 have revolutionized the treatment of relapsed or refractory aggressive B-cell lymphomas, and their use has increased the cure rate for these cancers from 10 to 40%. Two second-generation anti-CD19 CAR T-cell products, axicabtagene ciloleucel and tisagenlecleucel, have been approved for use in patients, and the approval of a third product, lisocabtagene maraleucel, is expected in 2020. The commercial availability of the first two products has facilitated the development of real-world experience in treating relapsed or refractory aggressive B-cell lymphomas, shed light on anti-CD19 CAR T-cell products' feasibility in trial-ineligible patients, and raised the need for strategies to mitigate the adverse effects associated with anti-CD19 CAR T-cell therapy, such as cytokine release syndrome, neurotoxicity, and cytopenia. In addition, promising clinical data supporting the use of anti-CD19 CAR T-cell therapy in patients with indolent B-cell lymphomas or chronic lymphocytic leukemia have recently become available, breaking the paradigm that these conditions are not curable. Multiple clinical CAR T-cell therapy-based trials are ongoing. These include studies comparing CAR T-cell therapy to autologous stem cell transplantation or investigating their use at earlier stages of disease, novel combinations, and novel constructs. Here we provide a thorough review on the use of the anti-CD19 CAR T-cell products axicabtagene ciloleucel, tisagenlecleucel and lisocabtagene maraleucel in patients with indolent or aggressive B-cell lymphoma or with chronic lymphocytic leukemia, and present novel CAR T cell-based approaches currently under investigation in these disease settings.
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Affiliation(s)
- Candida Vitale
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin, Italy
| | - Paolo Strati
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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