CAR-T Therapies Shown to Be Effective in Aggressive CLL Subtype

Chimeric antigen receptor (CAR) T-cell therapies effectively treated patients with Richter transformation (RT), an aggressive subtype of chronic lymphocytic leukemia (CLL), according to a report published in the Journal of Clinical Oncology.

The international multicenter retrospective study of patients with RT was led by Adam Kittai, MD, of the Ohio State University in Columbus.

The researchers enrolled 69 patients with RT who received a CAR-T therapy and analyzed patient, disease, and treatment features with descriptive statistics. Modeling analyses were used to identify factors associated with progression-free survival (PFS) and overall survival (OS).

Overall, the cohort had a median of four (range, 1-15) prior lines of therapy for CLL or RT, and 58 (84%) of patients previously received a Bruton tyrosine kinase or B-cell lymphoma 2 inhibitor. The median age at CAR-T infusion was 64 years (range, 27-80) and the CAR-T product used was axicabtagene ciloleucel in 44 patients (64%), tisagenlecleucel in 17 (25%), lisocabtagene maraleucel in seven (10%), and brexucabtagene autoleucel in one (1%).

The overall response rate was 63% with a complete response (CR) rate of 46%. The median duration of response was 27.6 months (95% CI, 14.5-not reached) in patients who achieved a CR.

After a median follow-up of 24 months from the date of CAR-T infusion, the estimated median PFS was 4.7 months (95% CI, 2.0-6.9) and two-year PFS was 29% (95% CI, 18-41). The estimated median OS was 8.5 months (95% CI, 5.1-25.4) and two-year OS was 38% (95% CI, 26-50).

Finally, the authors reported that eleven (16%) patients had grade 3 or higher cytokine release syndrome and 25 (37%) had immune effector cell-associated neurotoxicity syndrome.

Related: Study Identifies Prognostic Factors for Richter’s Transformation in Ibrutinib-Treated CLL

Reference

Kittai AS, Bond D, Huang Y, et al. Anti-CD19 chimeric antigen receptor t-cell therapy for Richter transformation: an international, multicenter, retrospective study. J Clin Oncol. 2024. doi:10.1200/JCO.24.00033