Frontiers in Oncology: Two-pronged approach: chemotherapy for tumor reduction + CAR-T treatment to improve the remission rate and overall survival rate of patients with high tumor burden lymphoma

The treatment response and prognosis of refractory/relapsed (R/R) diffuse large B-cell lymphoma (DLBCL) are poor

Since 2017, there have been 5 CAR-T cell therapies on the market, and CAR-T therapies have shown significant effects in B-cell malignancies

CAR-T therapy is usually associated with potentially fatal toxicities, including cytokine release syndrome (CRS) and neurotoxicity, especially in the case of high tumor burden

Recently, the team of Chief Physician Deng Qi of the First Central Hospital Affiliated to Nankai University published a title in Frontiers in Oncology (IF=6.

The team has previously demonstrated that CAR-T therapy in refractory/relapsed B-cell acute lymphoblastic leukemia (B-ALL) is related to high treatment response and controllable toxicity after enhanced lymphocyte depletion chemotherapy

Intensive chemotherapy is often used in the treatment of refractory/relapsed (R/R) diffuse large B-cell lymphoma (DLBCL), such as DHAP (dexamethasone, cisplatin, and cytarabine), DA-EPOCH (dose) Adjusted etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin), ICE (ifosfamide, carboplatin and etoposide) and GemOx (gemcitabine and oxaliplatin)

Since many patients with refractory/relapsed (R/R) diffuse large B-cell lymphoma (DLBCL) with large tumors can temporarily reduce their tumor burden after intensive chemotherapy, the research team speculates that reducing the patient’s tumor burden can Improve the effect of anti-CD19-CAR-T cell therapy

The research team recruited 57 patients with refractory/relapsed (R/R) diffuse large B-cell lymphoma (DLBCL) to participate in this clinical trial, of which 15 patients with high tumor burden received only cytoreductive chemotherapy

Twenty-five patients with high tumor burden received tumor-reducing chemotherapy followed by lymphocyte depletion chemotherapy

All patients were evaluated within 2 months after anti-CD19-CAR-T cell infusion

As a control group, the objective remission rate of 17 patients with low tumor burden who directly underwent CAR-T cell therapy was 88%

Among the groups receiving CAR-T therapy, there was no significant difference in the probability of cytokine release syndrome (CRS), no patients had neurological toxicity, and no patients died of cytokine release syndrome and neurotoxicity

The 1-year progression-free survival rate and overall survival rate of the 19 patients who received CAR-T treatment who were sensitive to chemotherapy were 52.

Overall, this clinical trial showed that effective chemotherapy for tumor reduction improved the objective response rate and overall survival rate of patients with high tumor burden, making it comparable to the results of patients with low tumor burden

Original source:

Cuicui Lyu, et al.