Comorbidities Predict Inferior Survival in Patients receiving Chimeric Antigen Receptor T-Cell Therapy for Diffuse Large B-Cell Lymphoma: A Multicenter Analysis

Lymphoma
02/10/2020

Biol Blood Marrow Transplant. 2020 Sep 29:S1083-8791(20)30621-2. doi: 10.1016/j.bbmt.2020.09.028. Online ahead of print.

ABSTRACT

BACKGROUND: Chimeric Antigen Receptor (CAR) T-cell therapy is approved for treatment of relapsed/refractory (R/R) Diffuse Large B-Cell Lymphoma (DLBCL). Here, we evaluate whether comorbidities, calculated by the Cumulative Illness Rating Scale (CIRS), predict survival for these patients.

METHODS: Retrospective chart review was performed at four academic institutes. All patients who underwent leukapheresis for commercial CAR T-cell therapy for R/R DLBCL were included. CIRS scores were calculated at time of leukapheresis. High comorbidity was defined as either CIRS ≥7, or presence of severe impairment (CIRS of 3/4 in ≥1 system; CIRS-3+). PFS and OS were estimated using the Kaplan-Meier method, and differences in curves were detected by log-rank test.

RESULTS: 130 patients were analyzed, 56.9%, and 56.2% had CIRS ≥7, and CIRS-3 respectively. After median follow-up of 13 months, median PFS was 6.7 months, and median OS was not reached. On univariable analysis ECOG performance status (PS) was associated with inferior PFS (HR=1.45, CI: 1.03-2.05, p=0.03) and OS (HR=1.76, CI: 1.17-2.64, p=0.007). Higher CIRS (CIRS ≥7 or CIRS-3+) was associated with inferior OS (HR=2.12, CI: 1.06-4.22, p=0.03) and a non-significant trend in worse PFS (HR=1.45, CI: 0.87-2.44, p=0.16). In multivariable analyses, CIRS ≥7 or CIRS-3+, and ECOG PS maintained independent prognostic significance.

CONCLUSIONS: Comorbidities as determined by CIRS and ECOG PS predict inferior survival in patients receiving CAR T-cell therapy for R/R DLBCL.