The following is a summary of “Outcomes of CD19 CAR T in Transformed Indolent Lymphoma Compared to De Novo Aggressive Large B-Cell Lymphoma,” published in the December 2024 issue of Hematology by Thiruvengadam et al. 

Chimeric antigen receptor (CAR) T-cell therapy has transformed treatment for aggressive large B-cell lymphoma (aLBCL). Outcomes for patients with transformed indolent non-Hodgkin lymphoma (tiNHL), a high-risk group, remain poorly understood. 

Researchers conducted a retrospective study on CAR T-cell therapy for aLBCL. 

They analyzed 1,182 patients with aLBCL treated with standard-of-care CAR T between 2017 and 2022, including 338 (29%) with tiNHL, in a multicenter retrospective study. 

The results showed similar rates of grade ≥3 cytokine release syndrome (CRS) in tiNHL and de novo cohorts (7% vs 8%, P=0.6) and lower grade ≥3 ICANS in tiNHL (21% vs 27%, P=0.02). Overall response rates (ORR) were similar (83% vs. 81%, P=0.3), while the complete response was higher in tiNHL (67% vs 59%, P=0.017). Median follow-up of 22.3 months showed similar progression free survival (PFS) (24-month: 41% [95% CI: 35%–46%] vs 38% [95% CI: 35%–42%]) and overall survival (OS) (24-month OS: 58% [95% CI: 52%–63%] vs 52% [95% CI: 48%–56%]). Adjusted analysis showed a trend toward lower risk of progression, relapse, or death in tiNHL (HR: 0.84 [95% CI: 0.69–1.0], P=0.07). Inferior PFS was linked to elevated LDH, advanced stage, prior bendamustine, bridging therapy, CNS involvement, and ≥3 prior therapies. 

Investigators found CAR T therapy to be highly effective with an acceptable toxicity profile in patients with tiNHL.  

Source: onlinelibrary.wiley.com/doi/10.1002/ajh.27548