PMID- 37317884 OWN - NLM STAT- MEDLINE DCOM- 20231103 LR - 20231107 IS - 1592-8721 (Electronic) IS - 0390-6078 (Print) IS - 0390-6078 (Linking) VI - 108 IP - 11 DP - 2023 Nov 1 TI - Salvage radiotherapy in relapsed/refractory large B-cell lymphoma after failure of CAR T-cell therapy. PG - 2972-2981 LID - 10.3324/haematol.2023.282804 [doi] AB - Despite the success of CD19-targeted chimeric antigen receptor (CAR T)-cell therapy in patients with relapsed/refractory large B-cell lymphoma (LBCL), there is a need for effective salvage strategies post-CAR T-cell therapy failure. We conducted a multi-institutional retrospective study of patients who relapsed following CAR T-cell therapy (axicabtagene ciloleucel [axi-cel] or tisagenlecleucel [tisa-cel]) and received salvage therapies (radiation therapy [RT] alone, systemic therapy alone, or combined modality therapy [CMT]). A total of 120 patients with post-CAR T relapsed LBCL received salvage therapies (RT alone, 25 patients; CMT, 15 patients; systemic therapy alone, 80 patients). The median follow-up from CAR T-cell infusion was 10.2 months (interquartile range, 5.2-20.9 months). Failure occurred in previously involved sites prior to CAR T-cell therapy in 78% of patients (n=93). A total of 93 sites were irradiated in 54 patients who received any salvage RT post-CAR T failure. The median dose/fractionation were 30 Gy (range, 4-50.4 Gy) and 10 fractions (range, 1-28 fractions). The 1-year local control rate for the 81 assessable sites was 84%. On univariate analysis, the median overall survival (OS) from the start date of RT was significantly higher among patients who received comprehensive RT versus focal RT (19.1 months vs. 3.0 months; P=<0.001). Twenty-three of 29 patients who received comprehensive RT had limited-stage disease. Among these, there was no difference in median OS among the patients who received RT alone versus those who received RT followed by additional therapies (log-rank P=0.2). On multivariate survival analysis, achieving PR or CR post-CAR T (hazard ratio =0.5; 95% confidence interval: 0.3-0.9; P=0.01) was independently associated with superior OS. Our findings suggest that RT can provide local control for LBCL relapsed post-CAR T-cell therapy, particularly in patients with limited-stage relapsed disease treated with comprehensive RT. FAU - Ababneh, Hazim S AU - Ababneh HS AD - Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston. FAU - Ng, Andrea K AU - Ng AK AD - Department of Radiation Oncology, Brigham and Women's Hospital, Boston. FAU - Frigault, Matthew J AU - Frigault MJ AD - Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston. FAU - Abramson, Jeremy S AU - Abramson JS AD - Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston. FAU - Johnson, Patrick Connor AU - Johnson PC AD - Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston. FAU - Jacobson, Caron A AU - Jacobson CA AD - Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA. FAU - Patel, Chirayu G AU - Patel CG AD - Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston. cpatel@mgh.harvard.edu. LA - eng PT - Journal Article DEP - 20231101 PL - Italy TA - Haematologica JT - Haematologica JID - 0417435 RN - 0 (Receptors, Chimeric Antigen) RN - 0 (Antigens, CD19) SB - IM MH - Humans MH - Immunotherapy, Adoptive/adverse effects MH - *Receptors, Chimeric Antigen MH - Retrospective Studies MH - *Lymphoma, Large B-Cell, Diffuse/radiotherapy MH - Survival Analysis MH - Antigens, CD19 PMC - PMC10620597 EDAT- 2023/06/15 06:42 MHDA- 2023/11/03 06:44 PMCR- 2023/06/15 CRDT- 2023/06/15 05:33 PHST- 2023/01/22 00:00 [received] PHST- 2023/11/03 06:44 [medline] PHST- 2023/06/15 06:42 [pubmed] PHST- 2023/06/15 05:33 [entrez] PHST- 2023/06/15 00:00 [pmc-release] AID - 10.3324/haematol.2023.282804 [doi] PST - epublish SO - Haematologica. 2023 Nov 1;108(11):2972-2981. doi: 10.3324/haematol.2023.282804.