Researchers at the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine have conducted a study suggesting that CAR-T immunotherapy remains a viable option for lymphoma patients who enter remission before the cell therapy begins.
Although the study does not definitively answer whether initiating cell therapy during remission is the right choice, it establishes that it is not the wrong choice. Dr. Trent Wang, a hematologist and cellular therapy specialist at Sylvester, presented the findings at the 65th ASH Annual Meeting and Exposition, the American Society of Hematology’s conference held in San Diego, California.Â
In the context of cell therapy, a form of immunotherapy that utilizes engineered immune cells (CAR-T cells) to target and combat cancer cells, patients often receive the treatment as a last resort after other therapies have failed. However, Dr. Wang observed an unusual occurrence in some lymphoma patients: complete remission before initiating cell therapy.Â
This unique situation arises during the waiting period before cell therapy, typically spanning three to five weeks. During this time, patients undergo processes such as insurance approval and the manufacturing of CAR-T cells from their own cells. As these patients are often critically ill, physicians may administer a short course of chemotherapy or other drugs to alleviate symptoms. Surprisingly, a small number of patients achieve remission during this pre-treatment waiting period.Â
Dr. Wang faced a dilemma in deciding whether to proceed with cell therapy for patients already in remission. The lack of information on this scenario prompted the researchers to conduct a study to assess the outcomes of such cases.
They proposed the study to the Center for International Blood & Marrow Transplant Research, a nationwide registry tracking patients who have undergone transplants and/or cell therapies. The study analyzed data from 134 patients in the registry who achieved complete remission before receiving cell therapy. This group was identified from screening records of over 5,000 cell therapy patients.
The results indicated that patients in remission during the waiting period had a 43% probability of progression-free survival over the two years following treatment, comparable to patients not in remission when receiving CAR-T. Importantly, patients in remission experienced lower levels of toxicities associated with cell therapy, such as cytokine release syndrome and neurotoxicity.Â
The study’s data encompassed patients treated with CAR-T cell therapy from 2015 to 2021, and the researchers aim to explore data reflecting more recent treatment trends. While the study does not definitively answer the question of whether cell therapy during remission is the optimal choice, it establishes the safety and reasonability of this approach.
Dr. Wang emphasized that the findings provide valuable information for clinicians faced with the dilemma of initiating cell therapy in patients already in remission, and the study contributes to the growing body of knowledge in the field of cellular therapy for cancer treatment.Â
Reference Â
Presentation Title: 615 Chimeric Antigen Receptor (CAR) T Cell Infusion for Large B Cell Lymphoma in Complete Remission: A Center for International Blood & Marrow Transplant Research (CIBMTR) Analysis. ash.confex.com/ash/2023/webpro … ram/Paper179223.html.Â
