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. 2021 Dec 2;13(23):6073.
doi: 10.3390/cancers13236073.

Transformed Lymphoma Is Associated with a Favorable Response to CAR-T-Cell Treatment in DLBCL Patients

Anna Nydegger  1 , Urban Novak  1 , Marie-Noëlle Kronig  1 , Myriam Legros  2 , Sacha Zeerleder  3 , Yara Banz  4 , Ulrike Bacher  3 , Thomas Pabst  1
Affiliations

Transformed Lymphoma Is Associated with a Favorable Response to CAR-T-Cell Treatment in DLBCL Patients

Anna Nydegger et al. Cancers (Basel). .

Abstract

(1) Background: CAR-T-cell therapy is a novel therapeutic option for patients with relapsed/refractory diffuse large B-cell lymphoma (r/r DLBCL). The parameters that predict a favorable outcome after CAR-T-cell treatment are a matter of ongoing exploration. (2) Methods: We analyzed 36 consecutive patients with r/r DLBCL receiving tisagenlecleucel or axicabtagene ciloleucel at a single academic institution. We hypothesized that lymphoma subtypes (transformed versus de novo DLBCL) are of prognostic importance. We also assessed age, previous treatment, bridging therapy, remission status at the time of CAR-T treatment and at six months, LDH, the occurrence of CRS or ICANS, and CAR-T-DNA ddPCR kinetics for their prognostic impact. (3) Results: CRS was observed in 24 (67%) patients, and ICANS was observed in 14 (39%) patients. CR was achieved in 20 (56%) patients. Achievement of CR within six months after CAR-T was associated with better PFS (p < 0.0001) and OS (p < 0.0001). Remarkably, transformed (=secondary) lymphoma was associated with a better outcome than de novo disease for PFS (p = 0.0093) and OS (p = 0.0209), and the CR rate was 78% versus 33% (p = 0.0176). Mortality in patients with transformed DLBCL was 23% compared with 56% in de novo patients (p = 0.0209). (4) Conclusion: The presence of transformed DLBCL seems to be associated with a more favorable course after CAR-T treatment than that observed in the de novo DLBCL patients.

Keywords: CAR-T-cell therapy; diffuse large B-cell lymphoma (DLBCL); prognosis; relapse; secondary DLBCL.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a) Progression-free survival and (b) overall survival after CAR-T-cell treatment in the total cohort. Starting time of PFS and OS is on the day of CAR-T infusion (day 0). The last follow-up and data cutoff were on 1 February 2021.
Figure 2
Figure 2
(a) Progression-free survival and (b) overall survival of the patients who did and did not achieve complete remission as a best response after CAR-T-cell therapy.
Figure 3
Figure 3
(a) Progression-free survival and (b) overall survival of the patients with de novo and transformed DLBCL. Progression-free survival of (c) patients with transformed lymphoma who reached a complete remission (CR) and who did not; and (d) of patients with de novo lymphoma who reached a CR and who did not. Overall survival of (e) patients with transformed lymphoma who reached a CR and who did not and (f) of patients with de novo lymphoma who reached a CR and who did not.
Figure 3
Figure 3
(a) Progression-free survival and (b) overall survival of the patients with de novo and transformed DLBCL. Progression-free survival of (c) patients with transformed lymphoma who reached a complete remission (CR) and who did not; and (d) of patients with de novo lymphoma who reached a CR and who did not. Overall survival of (e) patients with transformed lymphoma who reached a CR and who did not and (f) of patients with de novo lymphoma who reached a CR and who did not.
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