(214) Safety of Bridging Regimens Prior to Chimeric Antigen Receptor T-Cell (CAR-T) Therapy in Patients With Primary and Secondary CNS Lymphoma (Top Ten Poster)
PGY-2 Oncology Pharmacy Resident Massachusetts General Hospital Chelsea, Massachusetts, United States
Poster Abstract:
Background: Bridging therapy (BT) prior to CAR-T therapy for B-cell lymphomas is aimed at achieving optimal debulking and disease control while limiting adverse effects and considering patient-specific characteristics. Data surrounding BT for patients with primary and secondary CNS lymphoma is limited. Current guidelines recommend several BTs without a preferred regimen with no recommendations for Bruton’s Kinase inhibitors (BTKis). At our institution, BTKis have been used as an BT option. We aimed to evaluate the safety of BTKis and non-BTKis as BT prior to CD-19 directed CAR-T therapy in adults with primary and secondary CNS lymphoma at a single, large academic medical center.
Objective: Evaluate the safety of BTKis and non-BTKis as bridging therapies prior to and post CAR-T therapy in patients with primary and secondary CNS lymphoma.
Methods: This single-center retrospective cohort analysis included adults with primary and secondary CNS lymphoma who received BT prior to standard of care CD-19-directed CAR-T therapy between April 2, 2016, and July 1, 2023. Patients were excluded if they did not have an aggressive B-cell lymphoma diagnosis; received CAR-T therapy at an outside institution or investigational CAR-T therapy; or received steroid monotherapy, radiation, or an investigational regimen as BT. Patients were divided into the following BT groups for analysis: BTKis versus non-BTKis. The primary outcome was incidence of grade 3-4 infections. Secondary outcomes include the incidence of Cytokine Release Syndrome (CRS) and Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS), growth factor use, tumor lysis syndrome, non-hematologic laboratory abnormalities (e.g., serum creatinine, liver function tests) and hematologic laboratory abnormalities (e.g., anemia, neutropenia, and thrombocytopenia). Outcomes were assessed at the following time periods: start of BT to CAR-T infusion; CAR-T infusion to day 100 and at day 30, day 60, and day 100. Laboratory values were graded using CTCAE v5.0 and CRS and ICANS were graded using the 2019 American Society of Transplantation and Cellular Therapy (ASTCT) criteria. Descriptive statistics were used to analyze the primary and secondary outcomes.
Results: Pending
Discussion/
Conclusion: Pending results
References (must also be included in final poster): 1. B - Cell Lymphomas NCCN guidelines v2.2023: https://www.nccn.org/professionals/physician_gls/pdf/b - cell.pdf
4. Systematic review and meta-analysis of the association between bridging therapy and outcomes of chimeric antigen receptor T cell therapy in patients with large B cell lymphoma, 2022: https://pubmed.ncbi.nlm.nih.gov/35568624/
5. The impact of bridging therapy prior to CD19-directed chimeric antigen receptor T-cell therapy in patients with large B-cell lymphoma, 2021: https://pubmed.ncbi.nlm.nih.gov/34500492/
6. Effective bridging therapy can improve CD19 CAR - T outcomes while maintaining safety in patients with large B-cell lymphoma, 2023:https://pubmed.ncbi.nlm.nih.gov/36724512/
