PDF(Pubmed)
Abstract：
Patients with refractory or relapsed (R/R) large B-cell lymphoma (LBCL) refractory to first-line chemotherapy or with early relapse have poor outcomes. While chimeric antigen receptor (CAR) T-cell therapy has impressive efficacy after two or more lines of chemotherapy, it\'s still uncertain if these outcomes remain consistent in the context of third-line CAR T-cell therapy. We conducted a retrospective study of 107 R/R LBCL patients. Patients with relapse 12 months or more after their first-line chemoimmunotherapy (late failure: n = 25) had significantly longer overall survival (OS) than patients with refractory disease or relapse within 12 months (early failure: n = 82) (median OS: not achieved vs. 18.4 months; P < 0.001). Among patients who proceeded to autologous hematopoietic stem-cell transplantation (auto-HSCT), those with late failure had significantly longer event-free survival (EFS) than those with early failure (median EFS: 26.9 vs. 3.1 months; P = 0.012). However, no significant difference in EFS was detected among patients who underwent CAR T-cell therapy (median EFS: not reached vs. 11.8; P = 0.091). Cox regression with restricted cubic spline demonstrated that timing of relapse had significant impact on EFS in patients with auto-HSCT but not in patients with CAR T-cell therapy. Of patients who were scheduled for CAR T-cell therapy, those with late failure were significantly more likely to receive CAR T-cell therapy than those with early failure (90% vs. 57%; P = 0.008). In conclusion, patients with early failure still experienced poor outcomes after the approval of third-line CAR T-cell therapy.
摘要：
难治性或复发性（R/R）大B细胞淋巴瘤（LBCL）一线化疗难治或早期复发的患者预后较差。虽然嵌合抗原受体（CAR）T细胞疗法在两种或多种化疗方案后具有令人印象深刻的疗效，在三线CAR-T细胞治疗的背景下,这些结果是否保持一致仍不确定.我们对107例R/RLBCL患者进行了回顾性研究。一线化疗后12个月或更长时间复发的患者（晚期失败：n=25）的总生存期（OS）明显长于难治性疾病或12个月内复发的患者（早期失败：n=82）（中位OS：未达到vs.18.4个月；P<0.001）。在进行自体造血干细胞移植（auto-HSCT）的患者中，晚期失败患者的无事件生存期（EFS）明显长于早期失败患者（中位EFS：26.9vs.3.1个月；P=0.012）。然而,在接受CAR-T细胞治疗的患者中，EFS没有检测到显著差异(EFS中位数：未达到vs.11.8；P=0.091）。限制性三次样条的Cox回归表明，复发时间对自动HSCT患者的EFS有显著影响，但对CART细胞治疗患者没有影响。在计划接受CAR-T细胞治疗的患者中，与早期失败的患者相比，晚期失败的患者接受CART细胞治疗的可能性明显更高(90%vs.57%；P=0.008）。总之,在批准三线CAR-T细胞治疗后,早期失败患者的结局仍然较差.
