Outcomes among adult recipients of CD19 CAR T-cell therapy for Burkitt lymphoma

Background

Burkitt lymphoma (BL) is a rare, highly aggressive B-cell lymphoma associated with especially poor outcomes in patients with relapsed/refractory disease. Multiple CD19 chimeric antigen receptor (CAR) T-cell products have been FDA approved to treat relapsed/refractory B-cell non-Hodgkin lymphoma in the second-line setting, however little is known about CAR T-cell responses in patients with BL.

Methods

This multicenter, retrospective chart review was conducted by abstracting data from the medical charts of patients with BL who received CAR T-cell therapy. Demographic characteristics were assessed along with pre-CAR treatments, bridging therapies, infusion-related complications, CAR-T responses, and the use of post-CAR systemic therapy and/or hematopoietic stem cell transplant.

Results

A total of 24 patients with relapsed/refractory BL received CAR T-cell therapy after a median of 3 prior therapies (range 1-6). Most patients received axi-cel (n=16), although tisa-cel (n=4), liso-cel (n=3), and brexu-cel (n=1) were also represented. The median patient age was 37 (range 21-68) and 4 (16.7%) had a prior history of autologous stem cell transplant. The overall response rate 1 month after CAR-T infusion was 62.5% with a complete response rate of 58.3%. Only 2 patients experienced grade ≥3 CRS, whereas 5 patients experienced grade ≥3 ICANS. Twenty-eight-day mortality was 20.8%, including one patient who died from grade 4 ICANS. Regarding long term data, the median overall survival was 7.1 months (95% CI 1.9 – 12.9), and the median progression free survival was 3.1 months (95% CI 0.9 – 7.9). The median duration of response was 5.9 months (95% CI 3.1-9.0). Three (12.5%) patients received consolidative allogeneic stem cell transplants after CAR T-cell therapy, but all of them ultimately relapsed.

Conclusion

Relapsed/refractory BL is a rare and aggressive disease that remains challenging to treat despite the advent of CAR T-cell therapy. Further investigation is needed to determine the most effective management of these patients.