Roddie C, Neill L, Osborne W, et al. Effective Bridging Therapy Can Improve CD19 CAR-T Outcomes While Maintaining Safety in Patients with Large B-Cell Lymphoma. Blood Advances. 2023; (doi: 10.1182/bloodadvances.2022009019).
New research shows bridging therapy (BT) to be safe for patients with large B-cell lymphoma (LBCL) treated with an infusion of CD19-directed chimeric antigen receptor T-cell (CD19CAR-T). Researchers evaluated BT modality and response in 375 adult LBCL patients who received axicabtagene ciloleucel (Axi-cel) or tisagenlecleucel (Tisa-cel). Most patients were administered BT in conjunction with chemotherapy (57%) or radiotherapy (17%). The data indicate that disease progression and mortality declined 42% following CD19CAR-T therapy among patients who had a complete or partial response to BT. Response to last line therapy, lack of bulky disease, and use of polatuzumab-containing chemotherapy regimens were also associated with probable BT response. All Tisa-cel patients with less than a partial BT response saw frank relapse within a year of CD19CAR-T infusion, indicating that complete/partial response may have a greater bearing on Tisa-cel vs. Axi-cel. The findings support the need for careful planning of LBCL towards optimal response and disease debulking. Polatuzumab-containing chemotherapy regimens should be evaluated for all eligible patients, while additional lines of BT should be considered when a complete or partial response to BT before Tisa-cel is not possible.