101. Anti-CD19 chimeric antigen receptor T-cell therapy has less efficacy in Richter transformation than in de novo large B-cell lymphoma and transformed low-grade B-cell lymphoma
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Ohad Benjamini, Shalev Fried, Roni Shouval, Jessica R. Flynn, Ofrat Beyar-Katz, Lori A Leslie, Tsilla Zucherman, Ronit Yerushalmi, Noga Shem-Tov, Maria Lia Palomba, Ivetta Danylesko, Inbal Sdayoor, Hila Malka, Orit Itzhaki, Hyung Suh, Sean M. Devlin, Ronit Marcus, Parastoo B Dahi, Elad Jacoby, Gunjan L Shah, Craig S Sauter, Andrew Ip, Miguel-Angel Perales, Arnon Nagler, Avichai Shimoni, Michael Scordo, and Abraham Avigdor
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Diseases of the blood and blood-forming organs ,RC633-647.5 - Abstract
The activity of anti-CD19 CAR T cell therapy in chronic lymphocytic leukemia (CLL) with Richter's transformation (RT) to aggressive large B cell lymphoma (LBCL) is largely unknown. In a multicenter retrospective study, we report the safety and efficacy of CAR T cell therapy in patients with RT (n=30) compared to patients with aggressive B cell lymphoma (n=283) and patients with transformed indolent Non-Hodgkins Lymphoma (iNHL) (n=141) between April 2016 and January 2023. Two-thirds of patients received prior therapy for CLL before RT and 89% of them received B-cell receptor and B-cell lymphoma 2 (BCL-2) inhibitors. Toxicities of CAR T cell therapy in RT were similar to other lymphomas, with no fatalities related to cytokine release syndrome or immune effector-cell associated neurotoxicity synderome. The 100-day overall response rate and complete response rates in patients with RT were 57% and 47%, respectively. With a median follow up of 19 months, the median overall survival (OS) was 9.9 months in patients with RT compared to 18 months in de-novo LBCL and not reached in patients with transformed iNHL. The OS at 12 months was 45% in patients with RT compared with 62% and 75% in patients with de novo LBCL and transformed iNHL, respectively. In a multivariate analysis, worse OS was associated with RT histology, elevated LDH, and more prior lines of therapy. CAR T cell therapy can salvage a proportion of patients with CLL and RT exposed to prior targeted agents; however, efficacy in RT is inferior compared to de novo LBCL and transformed iNHL
- Published
- 2024
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