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Outcome and feasibility of radiotherapy bridging in large B‐cell lymphoma patients receiving CD19 CAR T in the UK
Summary Radiotherapy (RT) has potential synergistic effects with chimeric antigen receptor (CAR) T but is not widely used as bridging therapy due to logistical challenges and lack of standardised protocols. We analysed RT bridging in a multicentre national cohort of large B‐cell lymphoma patients ap...
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Published in: | British journal of haematology 2024-08, Vol.205 (2), p.483-494 |
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Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Format: | Article |
Language: | English |
Subjects: | |
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Online Access: | Get full text |
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Radiotherapy (RT) has potential synergistic effects with chimeric antigen receptor (CAR) T but is not widely used as bridging therapy due to logistical challenges and lack of standardised protocols. We analysed RT bridging in a multicentre national cohort of large B‐cell lymphoma patients approved for 3L axicabtagene ciloleucel or tisagenlecleucel across 12 UK centres. Of 763 approved patients, 722 were leukapheresed, 717 had data available on bridging therapy. 169/717 (24%) received RT bridging, 129 as single modality and 40 as combined modality treatment (CMT). Of 169 patients, 65.7% had advanced stage, 36.9% bulky disease, 86.5% elevated LDH, 41.7% international prognostic index (IPI) ≥3 and 15.2% double/triple hit at the time of approval. Use of RT bridging varied from 11% to 32% between centres and increased over time. Vein‐to‐vein time and infusion rate did not differ between bridging modalities. RT‐bridged patients had favourable outcomes with 1‐year progression‐free survival (PFS) of 56% for single modality and 47% for CMT (1‐year PFS 43% for systemic bridging). This is the largest cohort of LBCL patients receiving RT bridging prior to CAR T reported to date. Our results show that RT bridging can be safely and effectively used even in advanced stage and high‐risk disease, with low dropout rates and excellent outcomes.
Most LBCL patients planned for CD19 CAR T‐cell therapy receive ‘bridging therapy’ between leukapheresis and CAR T infusion to stabilise the disease during the weeks of CAR T manufacturing. Bridging therapy includes corticosteroids, systemic therapies such as immuno‐chemotherapy or novel agents, radiotherapy (RT) or combined modality treatment (CMT; systemic and RT bridging). Long‐term outcomes in patients receiving RT‐based bridging therapy are favourable and demonstrate that RT bridging can be successfully used even in advanced stage and high‐risk patients. |
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ISSN: | 0007-1048 1365-2141 1365-2141 |
DOI: | 10.1111/bjh.19453 |