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Outcome and feasibility of radiotherapy bridging in large B-cell lymphoma patients receiving CD19 CAR T in the UK

Lookup NU author(s): Dr Wendy Osborne

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Abstract

© 2024 British Society for Haematology and John Wiley & Sons Ltd.Radiotherapy (RT) has potential synergistic effects with chimeric antigen receptor (CAR) T but is not widely used as bridging therapy due to logistical challenges and lack of standardised protocols. We analysed RT bridging in a multicentre national cohort of large B-cell lymphoma patients approved for 3L axicabtagene ciloleucel or tisagenlecleucel across 12 UK centres. Of 763 approved patients, 722 were leukapheresed, 717 had data available on bridging therapy. 169/717 (24%) received RT bridging, 129 as single modality and 40 as combined modality treatment (CMT). Of 169 patients, 65.7% had advanced stage, 36.9% bulky disease, 86.5% elevated LDH, 41.7% international prognostic index (IPI) ≥3 and 15.2% double/triple hit at the time of approval. Use of RT bridging varied from 11% to 32% between centres and increased over time. Vein-to-vein time and infusion rate did not differ between bridging modalities. RT-bridged patients had favourable outcomes with 1-year progression-free survival (PFS) of 56% for single modality and 47% for CMT (1-year PFS 43% for systemic bridging). This is the largest cohort of LBCL patients receiving RT bridging prior to CAR T reported to date. Our results show that RT bridging can be safely and effectively used even in advanced stage and high-risk disease, with low dropout rates and excellent outcomes.

Publication metadata

Author(s): Kuhnl A, Roddie C, Kirkwood AA, Chaganti S, Norman J, Lugthart S, Osborne W, Gibb A, GonzalezArias C, Latif A, Uttenthal B, Seymour F, Jones C, Springell D, Brady JL, Illidge T, Stevens A, Alexander E, Hawley L, O'Rourke N, Bedi C, Prestwich R, Frew J, Burns D, O'Reilly M, Sanderson R, Sivabalasingham S, Mikhaeel NG

Publication type: Article

Publication status: Published

Journal: British Journal of Haematology

Year: 2024

Volume: 205

Issue: 2

Pages: 483-494

Print publication date: 01/08/2024

Online publication date: 09/04/2024

Acceptance date: 27/03/2024

ISSN (print): 0007-1048

ISSN (electronic): 1365-2141

Publisher: John Wiley and Sons Inc

URL: https://doi.org/10.1111/bjh.19453

DOI: 10.1111/bjh.19453

PubMed id: 38594876

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