Onkologie. 2024:18(2):103-108 | DOI: 10.36290/xon.2024.019

CAR T-lymphocytes in the treatment of non-Hodkgin's lymphoma: current perspectives

Kamila Polgárová
1. interní klinika - klinika hematologie, Všeobecná fakultní nemocnice a 1. lékařská fakulta Univerzity Karlovy, Praha

T-lymphocytes with chimeric antigen receptor have been used in the therapy of refractory or relapsed B-non-Hodgkin's lymphomas in the Czech Republic for several years. In the context of the available data, their use is expanding - in the sense of indicated diagnoses and also moving to earlier therapeutic lines. Some products are already approved for use in the Czech Republic in the second treatment line for diffuse large cell lymphoma; data reflecting front line use are also available. The spectrum of diagnoses for which this therapy has been approved currently includes mantle cell lymphoma and follicular lymphoma. Data from clinical trials and real-world evidence are increasing. At the same time, the etiopathogenesis of adverse effects is better understood, and the growing experience enables better management, which further improves the safety profile. It can thus be expected that the use of this immunotherapy will increase in the future in various patient populations.

Keywords: chimeric antigen receptor, B-NHL, immunotherapy.

Accepted: April 19, 2024; Published: May 3, 2024  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Polgárová K. CAR T-lymphocytes in the treatment of non-Hodkgin's lymphoma: current perspectives. Onkologie. 2024;18(2):103-108. doi: 10.36290/xon.2024.019.
Download citation

References

  1. Duell J, Lurati S, Dittrich M, et al. First Generation Chimeric Antigen Receptor Display Functional Defects In Key Signal Pathways Upon Antigen Stimulation. Blood (Internet). 2010;116:2088 LP-2088. Available from: http://www.bloodjournal.org/content/116/21/2088.abstract. Go to original source...
  2. Sadelain M, Brentjens R, Rivière I. The basic principles of chimeric antigen receptor design. Cancer Discov. 2013;3:388-398. Go to original source... Go to PubMed...
  3. O'Brien S, Nastoupil LJ, Essell J, et al. A First-in-Human Phase 1, Multicenter, Open-Label Study of CB-010, a Next-Generation CRISPR-Edited Allogeneic Anti-CD19 CAR-T Cell Therapy with a PD-1 Knockout, in Patients with Relapsed/Refractory B Cell Non-Hodgkin Lymphoma (ANTLER Study). Blood (Internet). 2022;140:9457-9458. Available from: https://doi.org/10.1182/blood-2022-168128. Go to original source...
  4. Sahillioglu AC, Schumacher TN. Safety switches for adoptive cell therapy. Curr Opin Immunol (Internet). 2022;74:190-198. Available from: https://www.sciencedirect.com/science/article/pii/S0952791521000893. Go to original source... Go to PubMed...
  5. Benmebarek M-R, Karches CH, Cadilha BL, et al. Killing Mechanisms of Chimeric Antigen Receptor (CAR) T Cells. Int J Mol Sci. 2019;20. Go to original source... Go to PubMed...
  6. Spiegel JY, Sahaf B, Hossain N, et al. Elevated Axicabtagene Ciloleucel (CAR-19) Expansion By Immunophenotyping Is Associated with Toxicity in Diffuse Large B-Cell Lymphoma. Blood (Internet). 2018;132:576 LP-576. Available from: http://www.bloodjournal.org/content/132/Suppl_1/576.abstract. Go to original source...
  7. Murthy H, Iqbal M, Chavez JC, et al. Cytokine Release Syndrome: Current Perspectives. ImmunoTargets Ther. 2019;8:43-52. Go to original source... Go to PubMed...
  8. Mucha SR, Rajendram P. Management and Prevention of Cellular-Therapy-Related Toxicity: Early and Late Complications. Curr. Oncol. 2023; p. 5003-5023. Go to original source... Go to PubMed...
  9. Jung S, Greiner J, von Harsdorf S, et al. Fatal late-onset CAR T-cell-mediated encephalitis after axicabtagene-ciloleucel in a patient with large B-cell lymphoma. Blood Adv. 2021;5:3789-3793. Go to original source... Go to PubMed...
  10. Hayden PJ, Roddie C, Bader P, et al. Management of adults and children receiving CAR T-cell therapy: 2021 best practice recommendations of the European Society for Blood and Marrow Transplantation (EBMT) and the Joint Accreditation Committee of ISCT and EBMT (JACIE) and the European Haemato. Ann. Oncol. Off. J. Eur. Soc. Med. Oncol. England; 2022; p. 259-275. Go to original source... Go to PubMed...
  11. Asokan S, Cullin N, Stein-Thoeringer CK, et al. CAR-T Cell Therapy and the Gut Microbiota. Cancers (Basel). 2023;15. Go to original source... Go to PubMed...
  12. Park JH, Sauter CS, Palomba ML, et al. A Phase II Study of Prophylactic Anakinra to Prevent CRS and Neurotoxicity in Patients Receiving CD19 CAR T Cell Therapy for Relapsed or Refractory Lymphoma. Blood (Internet). 2021;138:96. Available from: https://doi.org/10.1182/blood-2021-150431. Go to original source...
  13. Hanna KS, Kaur H, Alazzeh MS, et al. Cardiotoxicity Associated With Chimeric Antigen Receptor (CAR)-T Cell Therapy for Hematologic Malignancies: A Systematic Review. Cureus. 2022;14:e28162. Go to original source... Go to PubMed...
  14. Rejeski K, Wang Y, Hansen DK, et al. Applying the EHA/EBMT Grading for ICAHT after CAR-T: Comparative Incidence and Association with Infections and Mortality. Blood Adv. 2024. Go to original source...
  15. Lemoine J, Bachy E, Cartron G, et al. Nonrelapse mortality after CAR T-cell therapy for large B-cell lymphoma: a LYSA study from the DESCAR-T registry. Blood Adv. 2023;7:6589-6598. Go to original source... Go to PubMed...
  16. Rejeski K, Perez A, Sesques P, et al. CAR-HEMATOTOX: a model for CAR T-cell-related hematologic toxicity in relapsed/refractory large B-cell lymphoma. Blood. 2021;138:2499-2513. Go to original source... Go to PubMed...
  17. Rejeski K, Subklewe M, Aljurf M, et al. Immune effector cell-associated hematotoxicity: EHA/EBMT consensus grading and best practice recommendations. Blood (Internet). 2023;142:865-877. Available from: https://doi.org/10.1182/blood.2023020578. Go to original source... Go to PubMed...
  18. Vercellino L, Di Blasi R, Kanoun S, et al. Predictive factors of early progression after CAR T-cell therapy in relapsed/refractory diffuse large B-cell lymphoma. Blood Adv. 2020;4:5607-5615. Go to original source... Go to PubMed...
  19. Jaeger U, Bishop MR, Salles G, et al. Myc Expression and Tumor-Infiltrating T Cells Are Associated with Response in Patients (Pts) with Relapsed/Refractory Diffuse Large B-Cell Lymphoma (r/r DLBCL) Treated with Tisagenlecleucel in the Juliet Trial. Blood (Internet). 2020;136:48-49. Available from: https://doi.org/10.1182/blood-2020-137045. Go to original source...
  20. Locke FL, Oluwole OO, Kuruvilla J, et al. Association of Meta­bolic Tumor Volume (MTV) and Clinical Outcomes in Second-Line (2L) Relapsed/Refractory (R/R) Large B-Cell Lymphoma (LBCL) Following Axicabtagene Ciloleucel (Axi-Cel) Versus Standard-of-Care (SOC) Therapy in ZUMA-7. Blood (Internet). 2022;140:638-640. Available from: https://doi.org/10.1182/blood-2022-158492. Go to original source...
  21. Nastoupil LJ, Jain MD, Spiegel JY, et al. Axicabtagene Ciloleucel (Axi-cel) CD19 Chimeric Antigen Receptor (CAR) T-Cell Therapy for Relapsed/Refractory Large B-Cell Lymphoma: Real World Experience. Blood (Internet). 2018;132:91 LP-91. Available from: http://www.bloodjournal.org/content/132/Suppl_1/91.abstract. Go to original source...
  22. Locke FL, Miklos DB, Jacobson CA, et al. Axicabtagene Ciloleucel as Second-Line Therapy for Large B-Cell Lymphoma. N Engl J Med. 2022;386:640-654. Go to original source... Go to PubMed...
  23. Iacoboni G, Navarro V, Martín-López AÁ, et al. Recent Bendamustine Treatment Before Apheresis Has a Negative Impact on Outcomes in Patients With Large B-Cell Lymphoma Receiving Chimeric Antigen Receptor T-Cell Therapy. J Clin Oncol Off J Am Soc Clin Oncol. 2024;42:205-217. Go to original source... Go to PubMed...
  24. Greenbaum U, Hashmi H, Elsawy M, et al. Prognostic Impact of Comorbidities on Outcomes of Patients (pts) with Relapsed or Refractory Large B-Cell Lymphoma (r/r LBCL) Treated with Chimeric Antigen Receptor T-Cell Therapy (CART). Blood (Internet). 2022;140:4636-4638. Available from: https://doi.org/10.1182/blood-2022-169452. Go to original source...
  25. Jaglowski S, Hu Z-H, Zhang Y, et al. Tisagenlecleucel Chimeric Antigen Receptor (CAR) T-Cell Therapy for Adults with Diffuse Large B-Cell Lymphoma (DLBCL): Real World Experience from the Center for International Blood & Marrow Transplant Research (CIBMTR) Cellular Therapy (CT) Registry. Blood (Internet). 2019;134:766. Available from: https://doi.org/10.1182/blood-2019-130983. Go to original source...
  26. Yassine F, Iqbal M, Murthy H, et al. Real world experience of approved chimeric antigen receptor T-cell therapies outside of clinical trials. Curr Res Transl Med (Internet). 2020;68:159-170. Available from: https://www.sciencedirect.com/science/article/pii/S2452318620300386. Go to original source... Go to PubMed...
  27. Jacobson C, Locke FL, Ghobadi A, et al. Long-Term (≥ 4 Year and ≥ 5 Year) Overall Survival (OS) By 12- and 24-Month Event-Free Survival (EFS): An Updated Analysis of ZUMA-1, the Pivotal Study of Axicabtagene Ciloleucel (Axi-Cel) in Patients (Pts) with Refractory Large B-Cell Lymphoma (LBCL). Blood (Internet). 2021;138:1764. Available from: https://doi.org/10.1182/blood-2021-148078. Go to original source...
  28. Schuster SJ, Tam CS, Borchmann P, et al. Long-term clinical outcomes of tisagenlecleucel in patients with relapsed or refractory aggressive B-cell lymphomas (JULIET): a multicentre, open-label, single-arm, phase 2 study. Lancet Oncol (Internet). 2021;22:1403-1415. Available from: https://doi.org/10.1016/S1470-2045(21)00375-2. Go to original source... Go to PubMed...
  29. Bachy E, Le Gouill S, Di Blasi R, et al. A real-world comparison of tisagenlecleucel and axicabtagene ciloleucel CAR T cells in relapsed or refractory diffuse large B cell lymphoma. Nat Med. 2022;28:2145-2154. Go to original source... Go to PubMed...
  30. Kwon M, Iacoboni G, Reguera JL, et al. Axicabtagene ciloleucel compared to tisagenlecleucel for the treatment of aggressive B-cell lymphoma. Haematologica (Internet). 2022;108:110-121. Available from: https://haematologica.org/article/view/haematol.2022.280805. Go to original source... Go to PubMed...
  31. Kamdar M, Solomon SR, Arnason J, et al. Lisocabtagene maraleucel versus standard of care with salvage chemotherapy followed by autologous stem cell transplantation as second-line treatment in patients with relapsed or refractory large B-cell lymphoma (TRANSFORM): results from an interim analysi. Lancet (Internet). 2022;399:2294-2308. Available from: https://doi.org/10.1016/S0140-6736(22)00662-6. Go to original source... Go to PubMed...
  32. Bishop MR, Dickinson M, Purtill D, et al. Second-Line Tisagenlecleucel or Standard Care in Aggressive B-Cell Lymphoma. N Engl J Med. 2021;386:629-639. Go to original source... Go to PubMed...
  33. Houot R, Bachy E, Cartron G, et al. Axicabtagene ciloleucel as second-line therapy in large B cell lymphoma ineligible for autologous stem cell transplantation: a phase 2 trial. Nat Med (Internet). 2023;29:2593-2601. Available from: https://doi.org/10.1038/s41591-023-02572-5. Go to original source... Go to PubMed...
  34. Sehgal A, Hoda D, Riedell PA, et al. Lisocabtagene maraleucel as second-line therapy in adults with relapsed or refractory large B-cell lymphoma who were not intended for haematopoietic stem cell transplantation (PILOT): an open-label, phase 2 study. Lancet Oncol (Internet). 2022;23:1066-1077. Available from: https://doi.org/10.1016/S1470-2045(22)00339-4. Go to original source... Go to PubMed...
  35. Ayuk F, Gagelmann N, von Tresckow B, et al. Real-world results of CAR T-cell therapy for large B-cell lymphoma with CNS involvement: a GLA/DRST study. Blood Adv (Internet). 2023;7:5316-5319. Available from: https://doi.org/10.1182/bloodadvances.2023010336. Go to original source... Go to PubMed...
  36. Cook MR, Dorris CS, Makambi KH, et al. Toxicity and efficacy of CAR T-cell therapy in primary and secondary CNS lymphoma: a meta-analysis of 128 patients. Blood Adv. 2023;7:32-39. Go to original source... Go to PubMed...
  37. Jacobson CA, Falvey C, Bouvier R, et al. A Pilot Study of Axicabtagene Ciloleucel (axi-cel) for the Treatment of Relapsed/Refractory Primary and Secondary Central Nervous System Lymphoma (CNSL). Blood (Internet). 2022;140:1060-1061. Available from: https://doi.org/10.1182/blood-2022-165256. Go to original source...
  38. Chavez JC, Dickinson M, Munoz JL, et al. 3-Year Analysis of ZUMA-12: A Phase 2 Study of Axicabtagene Ciloleucel (Axi-Cel) As First-Line Therapy in Patients with High-Risk Large B-Cell Lymphoma (LBCL). Blood (Internet). 2023;142:894. Available from: https://doi.org/10.1182/blood-2023-174510. Go to original source...
  39. Ghione P, Palomba ML, Ghesquieres H, et al. Treatment patterns and outcomes in relapsed/refractory follicular lymphoma: results from the international SCHOLAR-5 study. Hae­matologica (Internet). 2022;108:822-832. Available from: https://haematologica.org/article/view/haematol.2022.281421. Go to original source... Go to PubMed...
  40. Rodgers TD, Casulo C, Boissard F, et al. Early Relapse in First-Line Follicular Lymphoma: A Review of the Clinical Implications and Available Mitigation and Management Strategies. Oncol Ther (Internet). 2021;9:329-346. Available from: https://doi.org/10.1007/s40487-021-00161-5. Go to original source... Go to PubMed...
  41. Fowler NH, Dickinson M, Dreyling M, et al. Tisagenlecleucel in adult relapsed or refractory follicular lymphoma: the phase 2 ELARA trial. Nat Med. 2022;28:325-332. Go to original source... Go to PubMed...
  42. Jacobson CA, Chavez JC, Sehgal AR, et al. Axicabtagene ciloleucel in relapsed or refractory indolent non-Hodgkin lymphoma (ZUMA-5): a single-arm, multicentre, phase 2 trial. Lancet Oncol (Internet). 2022;23:91-103. Available from: https://doi.org/10.1016/S1470-2045(21)00591-X. Go to original source... Go to PubMed...
  43. Morschhauser F, Dahiya S, Palomba ML, et al. TRANSCEND FL: PHASE 2 STUDY RESULTS OF LISOCABTAGENE MARALEUCEL (LISO-CEL) IN PATIENTS (PTS) WITH RELAPSED/REFRACTORY (R/R) FOLLICULAR LYMPHOMA (FL). Hematol Oncol (Internet). 2023;41:877-880. Available from: https://doi.org/10.1002/hon.3196_LBA4. Go to original source...
  44. Wang M, Munoz J, Goy A, et al. Three-Year Follow-Up of KTE-X19 in Patients With Relapsed/Refractory Mantle Cell Lymphoma, Including High-Risk Subgroups, in the ZUMA-2 Study. J Clin Oncol (Internet). 2022;JCO.21.02370. Available from: https://doi.org/10.1200/JCO.21.02370. Go to original source... Go to PubMed...
  45. Další literatura u autorky a na www.onkologiecs.cz
  46. Iacoboni G, Rejeski K, Villacampa G, et al. Real-world evidence of brexucabtagene autoleucel for the treatment of relapsed or refractory mantle cell lymphoma. Blood Adv. 2022. Go to original source...
  47. Maddocks K. Update on mantle cell lymphoma. Blood (Internet). 2018;132:1647-1656. Available from: https://doi.org/10.1182/blood-2018-03-791392. Go to original source... Go to PubMed...
  48. Todorovic Z, Todorovic D, Markovic V, et al. CAR T Cell Therapy for Chronic Lymphocytic Leukemia: Successes and Shortcomings. Curr Oncol. 2022;29:3647-3657. Go to original source... Go to PubMed...
  49. Iovino L, Shadman M. CAR T-cell therapy for CLL: a new addition to our treatment toolbox? Clin Adv Hematol Oncol. 2023;21:134-141.
  50. Barbanti MC, Appleby N, Kesavan M, et al. Cellular Therapy in High-Risk Relapsed/Refractory Chronic Lymphocytic Leu­kemia and Richter Syndrome. Front Oncol. 2022;12:888109. Go to original source... Go to PubMed...
  51. Douglas M. Richter Transformation: Clinical Manifestations, Evaluation, and Management. J Adv Pract Oncol. 2022;13:525-534. Go to original source... Go to PubMed...
  52. Foster C, Kuruvilla J. Treatment approaches in relapsed or refractory peripheral T-cell lymphomas (version 1; peer review: 3 approved). F1000Research (Internet). 2020;9. Available from: https://f1000research.com/articles/9-1091/v1. Go to original source... Go to PubMed...
  53. Zain JM, Hanona P. Aggressive T-cell lymphomas: 2021 Updates on diagnosis, risk stratification and management. Am J Hematol (Internet). 2021;96:1027-1046. Available from: https://doi.org/10.1002/ajh.26270. Go to original source... Go to PubMed...
  54. Polgárová K, Otáhal P, Šálek C, et al. Chimeric Antigen Receptor Based Cellular Therapy for Treatment Of T-Cell Malignancies. Front Oncol. 2022;12. Go to original source... Go to PubMed...
  55. Paul S, Pearlman AH, Douglass J, et al. TCR β chain-directed bispecific antibodies for the treatment of T cell cancers. Sci Transl Med (Internet). 2021/03/01. 2021;13:eabd3595. Available from: https://pubmed.ncbi.nlm.nih.gov/33649188. Go to original source... Go to PubMed...
  56. Liu E, Marin D, Banerjee P, et al. Use of CAR-Transduced Natural Killer Cells in CD19-Positive Lymphoid Tumors. N Engl J Med (Internet). 2020;382:545-553. Available from: https://pubmed.ncbi.nlm.nih.gov/32023374. Go to original source... Go to PubMed...
  57. Yang J, Yang X, Liu Y, et al. A Novel and Successful Patient or Donor-Derived CD7-Targeted CAR T-Cell Therapy for Relapsed or Refractory T-Cell Lymphoblastic Lymphoma (R/R T-LBL). Blood (Internet). 2021;138:652. Available from: https://doi.org/10.1182/blood-2021-147754. Go to original source...
  58. Shah NN, Flinn I, Kwon M, et al. CT-526 Updated Results From a Rapcabtagene Autoleucel (YTB323) Phase I Study Demonstrate Durable Efficacy and a Manageable Safety Profile in Patients With Relapsed or Refractory Diffuse Large B-Cell Lymphoma (R/R DLBCL). Clin Lymphoma Myeloma Leuk (Internet). 2023;23:S532-S533. Available from: https://www.sciencedirect.com/science/article/pii/S2152265023015203. Go to original source...
  59. Anguille S, Kuipers I, Saevels K, et al. Initial Clinical Results of Atalanta-1, a Phase I/II Trial of Point-of-Care Manufactured GLPG5102 (19CP02) in RR NHL. Blood (Internet). 2022;140:10323-10324. Available from: https://doi.org/10.1182/blood-2022-163830. Go to original source...
  60. Zhang L, Meng Y, Feng X, et al. CAR-NK cells for cancer immunotherapy: from bench to bedside. Biomark Res (Internet). 2022;10:12. Available from: https://doi.org/10.1186/s40364-022-00364-6. Go to original source... Go to PubMed...
  61. Yu S, Yi M, Qin S, et al. Next generation chimeric antigen receptor T cells: safety strategies to overcome toxicity. Mol Cancer (Internet). 2019;18:125. Available from: https://pubmed.ncbi.nlm.nih.gov/31429760. Go to original source... Go to PubMed...
  62. Martyniszyn A, Krahl A-C, Andre MC, et al. CD20-CD19 Bispecific CAR T Cells for the Treatment of B-Cell Malignancies. Hum Gene Ther. 2017;28:1147-1157. Go to original source... Go to PubMed...
  63. Palomba ML, Garcia J, Wang L, et al. TRANSCEND: Lisocabtagene Maraleucel (liso-cel; JCAR017) Healthcare Resource Utilization in Patients with Relapsed/Refractory Diffuse Large B-Cell Lymphoma (DLBCL). Blood (Internet). 2018;132:3545 LP- 3545. Available from: http://www.bloodjournal.org/content/132/Suppl_1/3545.abstract. Go to original source...
  64. Godwin JE, Mattar B, Maris M, et al. Outreach: Results from a Phase 2 Study of Lisocabtagene Maraleucel (liso-cel) Administered As Inpatient (Inpt) or Outpatient (Outpt) Treatment in the Nonuniversity Setting in Patients (Pts) with R/R Large B-Cell Lymphoma (LBCL). Blood (Internet). 2021;138:1762. Available from: https://doi.org/10.1182/blood-2021-148792. Go to original source...
  65. Siddiqi T, Soumerai JD, Dorritie KA, et al. Phase 1 TRANSCEND CLL 004 study of lisocabtagene maraleucel in patients with relapsed/refractory CLL or SLL. Blood. 2022;139:1794-1806. Go to original source... Go to PubMed...
  66. Kittai AS, Bond DA, William B, et al. Clinical activity of axicabtagene ciloleucel in adult patients with Richter syndrome. Blood Adv. 2020;4:4648-4652. Go to original source... Go to PubMed...
  67. Kittai AS, Bond DA, Huang Y, et al. Anti-CD19 Chimeric Antigen Receptor T-Cell Therapy for Richter's Transformation: An International Multicenter Retrospective Study. Blood (Internet). 2023;142:108. Available from: https://www.sciencedirect.com/science/article/pii/S0006497123047122. Go to original source...




Oncology

Madam, Sir,
please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

I declare:

  1. that I have met the above instruction
  2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited


No

Yes

If your statement is not true, please be aware
that brings the risk of danger to their health or the health of others.