Combinational therapy of CAR T-cell and HDT/ASCT demonstrates impressive clinical efficacy and improved CAR T-cell behavior in relapsed/refractory large B-cell lymphoma

• DOI: 10.1136/jitc-2024-008857
• Publication Date: 2024-04-17T04:06:46Z
• Authors: Wei Liu; Wei Liu; Hesong Zou; Lianting Chen; Wenyang Huang; Rui Lv; Yan Xu; Huimin Liu; Yin Shi; Kefei Wang; Yi Wang; Wenjie Xiong; Shuhui Deng; Shuhua Yi; Weiwei Sui; Guangxin Peng; Yueshen Ma; Huijun Wang; Lulu Lv; Jianxiang Wang; Jun Wei; Lugui Qiu; Wenting Zheng; Dehui Zou
• Keywords: Clinical/Translational Cancer Immunotherapy; 0301 basic medicine; 0303 health sciences; T-Lymphocytes; Hematopoietic Stem Cell Transplantation; Neoplasms. Tumors. Oncology. Including cancer and carcinogens; Transplantation, Autologous; Treatment Outcome; Leukocytes, Mononuclear; Humans; Lymphoma, Large B-Cell, Diffuse; Neoplasm Recurrence, Local; RC254-282

BackgroundApproximately two-thirds of patients with relapsed or refractory large B-cell lymphoma (R/R LBCL) do not respond to or relapse after anti-CD19 chimeric antigen receptor T (CAR T)-cell therapy, leading to poor outcomes. Previous studies have suggested that intensified lymphodepletion and hematological stem cell infusion can promote adoptively transferred T-cell expansion, enhancing antitumor effects. Therefore, we conducted a phase I/II clinical trial in which CNCT19 (an anti-CD19 CAR T-cell) was administered after myeloablative high-dose chemotherapy and autologous stem cell transplantation (HDT/ASCT) in patients with R/R LBCL.MethodsTransplant-eligible patients with LBCL who were refractory to first-line immunochemotherapy or experiencing R/R status after salvage chemotherapy were enrolled. The study aimed to evaluate the safety and efficacy of this combinational therapy. Additionally, frozen peripheral blood mononuclear cell samples from this trial and CNCT19 monotherapy studies for R/R LBCL were used to evaluate the impact of the combination therapy on the in vivo behavior of CNCT19 cells.ResultsA total of 25 patients with R/R LBCL were enrolled in this study. The overall response and complete response rates were 92.0% and 72.0%, respectively. The 2-year progression-free survival rate was 62.3%, and the overall survival was 68.5% after a median follow-up of 27.0 months. No unexpected toxicities were observed. All cases of cytokine release syndrome were of low grade. Two cases (8%) experienced grade 3 or higher CAR T-cell-related encephalopathy syndrome. The comparison of CNCT19 in vivo behavior showed that patients in the combinational therapy group exhibited enhanced in vivo expansion of CNCT19 cells and reduced long-term exhaustion formation, as opposed to those receiving CNCT19 monotherapy.ConclusionsThe combinational therapy of HDT/ASCT and CNCT19 demonstrates impressive efficacy, improved CNCT19 behavior, and a favorable safety profile.Trial registration numbersChiCTR1900025419 andNCT04690192.