Table 1.
Characteristics and results of initial reports of radiation therapy as bridging treatment prior to CD-19 CAR T-cell therapy among non-Hodgkin lymphoma patients.
| Study | Moffitt [Sim et al. (24)] | MDACC [Pinnix et al. (25)] | UPenn [Wright et al. (27)] |
|---|---|---|---|
| Patient population | R/R DLBCL, tFL | R/R DLBCL, tFL, PMBCL | R/R aggressive B-cell lymphoma |
| Product | Axi-cel | Axi-cel | Axi-cel (n = 18), tisa-cel (n = 13) |
| Total # Pts apheresed | 12 | 148 | 31 |
| Received CAR T, % | 92% (n = 11) | 84% (n = 124) | 100% (n = 31) |
| Received bridging therapy, % | 100% (n = 12) | 50% (n = 62) | NR |
| Received RT bridging (%) | |||
| RT alone, % | 42% (n = 5) | 65% (n = 11) | 60% (n = 3) |
| CMT, % | 58% (n = 7) | 35% (n = 6) | 40% (n = 2) |
| Median RT dose, Gy (range) | 20 Gy (6–30) | 35 Gy (9–46) | 37.5 Gy (20–45) |
| RT fraction range | 2–4 Gy | 1.8–5 Gy | 2.2–4 Gy |
| Timing of RT bridging | |||
| Before apheresis, % | 17% (n = 2) | 35% (n = 6) | NR |
| After apheresis, % | 83% (n = 10) | 65% (n = 11) | |
| RT field size | |||
| Comprehensive, % | 42% (n = 5) | 53% (n = 9) | 60% (n = 3) |
| Focal, % | 58% (n = 7) | 47% (n = 8) | 40% (n = 2) |
| CRS grade ≥3, % | 8% (n = 1) | 6% (n = 1) | 0% (n = 0) |
| ICANS grade ≥3, % | 25% (n = 3) | 35% (n = 6) | 0% (n = 0) |
| Median follow up time (range) | 3.3 months (1.1–12) | 11.1 months (95% CI 9.9–12.3) | 12.3 months (9.8–19.9) |
| ORR | 81.8% | 100% for RT alone, 67% for CMT | 80% |
| CR rate | 45.5% | 82% for RT alone, 67% for CMT | 60% |
| 1-year PFS | NR | 44% RT alone, 25% CMT | 20% |
| 1-year OS | NR | 63% RT alone, 25% CMT | 80% |
R/R, relapsed and refractory; DLBCL, diffuse large B-cell lymphoma; tFL, transformed follicular lymphoma, PMBCL, primary mediastinal B-cell lymphoma; axi-cel, axicabtagene ciloleucel; tisa-cel, tisagenlecleucel; Pts, patients, CAR T, chimeric antigen receptor T cell therapy; RT, radiation therapy; NR, not reported; CMT, combined modality therapy; Gy, gray; CRS, cytokine release syndrome; ICANS, immune effector cell-associated neurotoxicity syndrome; CI, confidence interval; ORR, overall response rate; CR, complete response; PFS, progression free survival; OS, overall survival.