Tisagenlecleucel in Adult Relapsed or Refractory Diffuse Large B‐Cell Lymphoma
By S. Schuster, M. Bishop, C. Tam, E. Waller, P. Borchmann, J. Mcguirk, U. Jäger, S. Jaglowski, C. Andreadis, J. Westin and 14 more. New England Journal of Medicine, 2019
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BACKGROUND Patients with diffuse large B‐cell lymphoma that is refractory to primary and second‐line therapies or that has relapsed after stem‐cell transplantation have a poor prognosis. The chimeric antigen receptor (CAR) T‐cell therapy tisagenlecleucel targets and eliminates CD19‐expressing B cells and showed efficacy against B‐cell lymphomas in a single‐center, phase 2a study. METHODS We conducted an international, phase 2, pivotal study of centrally manufactured tisagenlecleucel involving adult patients with relapsed or refractory diffuse large B‐cell lymphoma who were ineligible for or had disease progression after autologous hematopoietic stem‐cell transplantation. The primary end point was the best overall response rate (i.e., the percentage of patients who had a complete or partial response), as judged by an independent review committee. RESULTS A total of 93 patients received an infusion and were included in the evaluation of efficacy. The median time from infusion to data cutoff was 14 months (range, 0.1 to 26). The best overall response rate was 52% (95% confidence interval, 41 to 62); 40% of the patients had complete responses, and 12% had partial responses. Response rates were consistent across prognostic subgroups. At 12 months after the initial response, the rate of relapse‐free survival was estimated to be 65% (79% among patients with a complete response). The most common grade 3 or 4 adverse events of special interest included cytokine release syndrome (22%), neurologic events (12%), cytopenias lasting more than 28 days (32%), infections (20%), and febrile neutropenia (14%). Three patients died from disease progression within 30 days after infusion. No deaths were attributed to tisagenlecleucel, cytokine release syndrome, or cerebral edema. No differences between response groups in tumor expression of CD19 or immune checkpoint–related proteins were found. CONCLUSIONS In this international study of CAR T‐cell therapy in relapsed or refractory diffuse large B‐cell lymphoma in adults, high rates of durable responses were produced with the use of tisagenlecleucel. (Funded by Novartis; JULIET ClinicalTrials.gov number, NCT02445248.)
Subfields: Genetics, Immunology, Oncology
View Paper: https://www.semanticscholar.org/paper/268db5eb477e42dea4ac9ac837b30dad4240af12
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Citations in the corpus
- ASBMT Consensus Grading for Cytokine Release Syndrome and Neurological Toxicity Associated with Immune Effector Cells (2018, background): “In this new fi eld of medicine, companies may have to face the possibility of a gap between what the FDA or European Medicines Agency (EMA) wants them to collect and what centers are actually able to provide.”
- KTE-X19 CAR T-Cell Therapy in Relapsed or Refractory Mantle-Cell Lymphoma. (2020, background): “Eligible adults (≥18 years of age) had histologically confirmed mantle-cell lymphoma with either cyclin D1 overexpression or presence of the translocation t(11;14) and had disease that was either relapsed or refractory to up to five previous regimens for mantle-cell lymphoma (see the Supplementary M”