医学
内科学
单变量分析
胃肠病学
国际预后指标
乳酸脱氢酶
肿瘤科
耐火材料(行星科学)
淋巴瘤
置信区间
弥漫性大B细胞淋巴瘤
无进展生存期
多元分析
化疗
生物
天体生物学
酶
生物化学
作者
Laëtitia Vercellino,Roberta Di Blasi,Salim Kanoun,Benoît Tessoulin,Cédric Rossi,Maud D’aveni-Piney,Lucie Obéric,Caroline Bodet-Milin,Pierre Bories,Pierre Olivier,Ingrid Lafon,Alina Berriolo-Riedinger,Eugenio Galli,Sophie Bernard,Marie‐Thérèse Rubio,Céline Bossard,Véronique Meignin,Pascal Merlet,Pierre Feugier,Steven Le Gouill,Loïc Ysebaert,Olivier Casasnovas,Michel Meignan,Sylvie Chevret,Catherine Thiéblemont
出处
期刊:Blood Advances
[American Society of Hematology]
日期:2020-11-12
卷期号:4 (22): 5607-5615
被引量:245
标识
DOI:10.1182/bloodadvances.2020003001
摘要
Chimeric antigen receptor (CAR) T-cell therapy has emerged as an option for relapsed/refractory aggressive B-cell lymphomas that have failed 2 lines of therapy. Failures usually occur early after infusion. The purpose of our study was to identify factors that may predict failure, particularly early progression (EP), within the first month after infusion. Characteristics of 116 patients were analyzed at the time of decision (TD) to use commercial CAR (axicabtagene ciloleucel, n = 49; tisagenlecleucel n = 67) and at the time of treatment (TT), together with total metabolic tumor volume (TMTV) at TT. With a median follow-up of 8.2 months, 55 patients failed treatment; 27 (49%) were early progressors. The estimated 12-month progression-free survival (PFS) and overall survival (OS) were 47.2% (95% confidence interval [CI], 38.0-58.6) and 67.0% (95% CI, 57-79), respectively. Univariate analyses for PFS and OS identified Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≥2, stage III/IV disease, extranodal (EN) sites ≥2, elevated lactate dehydrogenase (LDH), increased C-reactive protein (CRP), high International Prognostic Index at TD and at TT, as well as increased CRP, bulky mass, and high TMTV at TT, as risk factors. Multivariate analyses for PFS, EP, and OS identified elevated LDH and EN sites ≥2 at TD and the same predictors at TT (ie, increased CRP, EN sites ≥2, and TMTV >80 mL). In summary, risk factors identified for early progression at TD and at TT were EN involvement (≥2 sites) and lymphoma burden (LDH, TMTV).