In a retrospective study reported in the Journal of Clinical Oncology, Kittai et al found that anti-CD19 chimeric antigen receptor (CAR) T-cell therapy showed activity in previously treated patients with Richter transformation.
Study Details
In the study, 69 patients who received CAR T-cell therapy for Richter transformation were identified at 12 academic centers in the United States and Australia. The median age at CAR T-cell therapy infusion was 64 years (range = 27–80 years). Patients had received a median of four (range = 1–15) previous lines of therapy for chronic lymphocytic leukemia or Richter transformation, including BTK or BCL2 inhibitor therapy in 58 patients (84%). The CAR T-cell product received was axicabtagene ciloleucel in 44 patients (64%), tisagenlecleucel in 17 (25%), lisocabtagene maraleucel in 7 (10%), and brexucabtagene autoleucel in 1 (1%).
Key Findings
The overall response rate was 64%, with complete response in 32 patients (46%) and partial response in 12 (17%). Among patients with complete response, median duration of response was 27.6 months (95% confidence interval [CI] = 14.5 months to not reached). Among patients with partial response, median response duration was 2.1 months (95% CI = 1.0–3.3 months).
After a median follow-up of 24 months, median progression-free survival was 4.7 months (95% CI = 2.0–6.9 months); rates at 1 and 2 years were 35.7% (95% CI = 24.3%–47.3%) and 28.9% (95% CI = 17.8%–40.8%). Median overall survival was 8.5 months (95% CI = 5.1–25.4 months); rates at 1 and 2 years were 42.9% (95% CI = 30.7%–54.4%) and 38% (95% CI = 26%–50%).
Grade ≥ 3 cytokine-release syndrome and immune effector cell–associated neurotoxicity syndrome occurred in 16% and 37% of patients, respectively. A total of 12 patients had nonrelapse mortality; causes were infection in 9 (COVID-19 infection in 4), respiratory failure, intracranial bleed, and stroke.
The investigators concluded, “CAR T-cell therapy demonstrates clinical efficacy for patients with Richter transformation.”
Adam S. Kittai, MD, of the Division of Hematology, The Ohio State University, Columbus, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the U.S. National Institutes of Health. For full disclosures of the study authors, visit ascopubs.org.
