CAR T-cell therapy for relapsed and refractory B-cell non-Hodgkin lymphoma: a single-centre 5-year real-world experience study at Ghent University Hospital.

Background

Relapsed or refractory (R/R) B-cell non-Hodgkin lymphoma (B-NHL) remains challenging to treat, particularly in patients ineligible for high-dose chemotherapy and autologous stem cell transplantation. Chimeric antigen receptor (CAR) T-cell therapy has emerged as a promising treatment.

Aims

We describe the epidemiology, demographics and outcomes of patients receiving CAR T-cell therapy for R/R DLBCL (including transformed follicular lymphoma [TFL]), high-grade B-cell lymphoma (HGBCL) and mantle cell lymphoma (MCL) at Ghent University Hospital between 2019 and 2024. We assessed associations between disease subtype, remission status, acute toxicity and survival.

Methods

We retrospectively analyzed 84 eligible patients, of whom 83 received CAR T-cell infusion with tisagenlecleucel (n=20), axicabtagene ciloleucel (n=53) or brexucabtagene autoleucel (n=10). The cohort included DLBCL (n=47), TFL (n=13), HGBCL (n=13) and MCL (n=10). The objective response rate (ORR) at 1 month was 85.6%, with a complete response (CR) rate of 49.4%. At a median follow-up of 11.7 months, ORR increased to 90.3% and CR to 68.7%. Median overall survival was 29.9 months. Patients achieving PR/CR at 1 month had significantly improved long-term survival (p=0.002). Lower total metabolic tumor volume at infusion was associated with a trend toward better survival. Cytokine release syndrome (CRS) occurred in 90.4%, predominantly low grade, with grade 3-4 CRS in 1.2%. Immune effector cell-associated neurotoxicity syndrome (ICANS) occurred in 65.1%, with grade 3-4 events in 15.6%.

Conclusion

This real-world cohort confirms high response rates and favorable survival following CAR T-cell therapy in R/R B-NHL and explores potential predictive markers associated with long-term survival.