Predictors of response to axicabtagene‐ciloleucel CAR T cells in aggressive B cell lymphomas: A real‐world study

Chimeric antigen receptor T‐cell (CAR T) therapy has shown promising efficacy in relapsed and refractory diffuse large B cell lymphoma (DLBCL). While most patients undergo CAR T infusion with active disease, the impact of some clinical variables, such as responsiveness to the pre‐CAR T chemotherapy on the response to CAR T, is unknown. In this single‐institution study, we studied the impact of several pre‐CAR T variables on the post‐CAR outcomes. Sixty patients underwent apheresis for axicabtagene‐ciloleucel (axi‐cel) and 42 of them (70.0%) had primary refractory disease. Bridging therapy between apheresis and lymphodepletion was given in 34 patients (56.7%). After axi‐cel, the overall response rate was 63.3%. Responsiveness to the immediate pre‐CAR T therapy did not show a significant association with response to axi‐cel, progression‐free (PFS) or overall (OS) survival. Multivariable analysis determined that bulky disease before lymphodepletion was independently associated with inferior outcomes, and patients that presented with high‐burden disease unresponsive to immediate pre‐CAR T therapy had a dismal outcome. This data supports proceeding with treatment in CAR T candidates regardless of their response to immediate pre‐CAR T therapy. Interim therapeutic interventions should be considered in patients who have known risk factors for poor outcomes (bulky disease, high LDH).