Incorporating radiation with anti‐CD19 chimeric antigen receptor T‐cell therapy for relapsed/refractory non‐Hodgkin lymphoma: A multicenter consensus approach

推车 医学 嵌合抗原受体 放射治疗 疾病 肿瘤科 淋巴瘤 细胞因子释放综合征 内科学 挽救疗法 免疫疗法 化疗 癌症 机械工程 工程类
作者
Omran Saifi,Scott C. Lester,William G. Breen,William G. Rule,Yi Lin,N. Nora Bennani,Allison Rosenthal,Javier Muñoz,Hemant S. Murthy,Mohamed A. Kharfan‐Dabaja,Jennifer Peterson,Bradford S. Hoppe
出处
期刊:American Journal of Hematology [Wiley]
卷期号:99 (1): 124-134 被引量:4
标识
DOI:10.1002/ajh.27155
摘要

Abstract Anti‐CD19 chimeric antigen receptor T‐cell therapy (CART) has revolutionized the outcomes of relapsed and/or refractory B‐cell non‐Hodgkin lymphoma. However, CART is still limited by its availability, toxicity, and response durability. Not all patients make it to the CART infusion phase due to disease progression. Among those who receive CART, a significant number of patients experience life‐threatening cytokine release syndrome toxicity, and less than half maintain a durable response with the majority relapsing in pre‐existing sites of disease present pre‐CART. Radiation therapy stands as a promising peri‐CART and salvage treatment that can improve the outcomes of these patients. Evidence suggests that bridging radiotherapy prior to CART controls the disease during the manufacturing period, augments response rates and local control, cytoreduces/debulks the disease and decreases the severity of cytokine release syndrome, and may prolong disease‐free intervals and survival especially in patients with bulky disease. Consolidative radiotherapy for residual post‐CART disease alters the pattern of relapse and improves local recurrence‐free and progression‐free survivals. Salvage radiotherapy for relapsed post‐CART disease has favorable survival outcomes when delivered comprehensively for patients with limited relapsed disease and palliates symptoms for patients with diffuse relapsed disease. The biology of the disease during the peri‐CART period is poorly understood, and further studies investigating the optimal timing and dosing of radiation therapy (RT) are needed. In this review, we tackle the most significant challenges of CART, review and propose how RT can help mitigate these challenges, and provide The Mayo Clinic experts' approach on incorporating RT with CART.
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