ESTRO 2024 - Abstract Book

S1158

Clinical - Haematology

ESTRO 2024

Results:

The median age of patients was 60 years (range 40-75). The majority of patients had a diagnosis of diffuse large B cell lymphoma (n=8), however , the group included mantle cell (n=1), Burkitt's (n=1) and high-grade transformation of follicular lymphoma (n=4). In keeping with its indications, patients had received a minimum of 2 lines of prior treatment (2 lines: n=2, 3 lines: n=5, 4 lines: n = 1). 9 (50%) patients received bridging radiotherapy. 5 of these patients had received radiotherapy earlier in their treatment. Sites treated were lung (n=2), axilla (n=3), thoracic spine (n=2) and abdominal sites (n =2). Most patients received palliative dose fractionation of 20Gy in 5 fractions (89%, n=8) with 1 (11%) patient receiving 24Gy in 12 fractions. Of the 18 patients referred, 14 received CAR-T cell therapy. 6 of these patients (43%) received bridging radiotherapy. The 4 patients who did not receive treatment had declining fitness or rapid progression of disease while awaiting infusion. 3 of these patients had received bridging radiotherapy in an attempt to control there disease prior to infusion. The time between referral for CAR-T cell therapy and infusion was a median of 62 days. The median duration of admission was 30 days (range 12-134 days). 6 patients had progressive disease confirmed within 6 months. 33% (n=2) of these patients had received bridging radiotherapy. In both cases, progression was out with the radiotherapy field. 57% (n=8) had a confirmed complete response. 10 patients have died. This includes 3 patients considered to have a complete response who have died due to other disease processes.

Conclusion:

In conclusion, the response rate in this real-life population is comparable to the pivotal data (1). The time between referral and infusion as well as a proportion of patients not being fit enough to receive systemic treatment, indicates a need for bridging therapy. The results from this small review suggests that radiotherapy is an appropriate bridging option in this chemotherapy refractory group of patients. Its use should be considered promptly following referral for CAR-T cell therapy.

Keywords: CAR-T, Bridging radiotherapy, Lymphoma

References:

Neelapu SS, Locke FL, Bartlett NL, et al. Axicabtagene ciloleucel CAR T-cell therapy in refractory large B-cell lymphoma. N Engl J Med. 2017;377(26):2531-2544.

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