CNS-BRT for cytoreduction before CAR T-cell infusion for CNSL
Cederquist G, Schefflein J, Devlin SM, et al. CNS Bridging Radiotherapy Achieves Cytoreduction Prior to CAR T Cell Therapy for Aggressive B-Cell Lymphoma. Blood Advances. 2024; (doi: 10.1182/bloodadvances.2024013393).
Preliminary data support bridging radiotherapy (BRT) as a pathway to rapid, significant cytoreduction in patients with central nervous system lymphoma (CNSL) before they undergo chimeric antigen receptor T-cell (CAR T) therapy. Researchers tracked 12 CNS-BRT recipients, including 10 CNSL patients with progressive non-Hodgkin B-cell lymphoma, for a median 11.8 months. Delivery of CNS-BRT reduced lesion size a mean 74% from baseline measurements at a median 12 days after BRT completion and ahead of CAR T administration. With 8 complete CNS responses and 1 partial response, the results were considered promising. The safety profile of CNS-BRT was also deemed acceptable, with only a single patient developing grade 3 or higher cytokine release syndrome and three experiencing grade 3 or higher immune effector cell-associated neurotoxicity syndrome.