TY - JOUR
T1 - Tisagenlecleucel in adult relapsed or refractory diffuse large B-cell lymphoma
AU - JULIET Investigators
AU - Schuster, Stephen J.
AU - Bishop, Michael R.
AU - Tam, Constantine S.
AU - Waller, Edmund K.
AU - Borchmann, Peter
AU - McGuirk, Joseph P.
AU - Jäger, Ulrich
AU - Jaglowski, Samantha
AU - Andreadis, Charalambos
AU - Westin, Jason R.
AU - Fleury, Isabelle
AU - Bachanova, Veronika
AU - Ho, P. Joy
AU - Mielke, Stephan
AU - Magenau, John M.
AU - Holte, Harald
AU - Pantano, Serafino
AU - Pacaud, Lida B.
AU - Awasthi, Rakesh
AU - Chu, Jufen
AU - Anak, Özlem
AU - Salles, Gilles
AU - Maziarz, Richard T.
N1 - Publisher Copyright:
Copyright © 2018 Massachusetts Medical Society.
PY - 2019/1/3
Y1 - 2019/1/3
N2 - BACKGROUND: Patients with diffuse large B-cell lymphoma that is refractory to primary and second-line therapies or that has relapsed after stem-cell transplantation have a poor prognosis. The chimeric antigen receptor (CAR) T-cell therapy tisagenlecleucel targets and eliminates CD19-expressing B cells and showed efficacy against B-cell lymphomas in a single-center, phase 2a study.METHODS: We conducted an international, phase 2, pivotal study of centrally manufactured tisagenlecleucel involving adult patients with relapsed or refractory diffuse large B-cell lymphoma who were ineligible for or had disease progression after autologous hematopoietic stem-cell transplantation. The primary end point was the best overall response rate (i.e., the percentage of patients who had a complete or partial response), as judged by an independent review committee.RESULTS: A total of 93 patients received an infusion and were included in the evaluation of efficacy. The median time from infusion to data cutoff was 14 months (range, 0.1 to 26). The best overall response rate was 52% (95% confidence interval, 41 to 62); 40% of the patients had complete responses, and 12% had partial responses. Response rates were consistent across prognostic subgroups. At 12 months after the initial response, the rate of relapse-free survival was estimated to be 65% (79% among patients with a complete response). The most common grade 3 or 4 adverse events of special interest included cytokine release syndrome (22%), neurologic events (12%), cytopenias lasting more than 28 days (32%), infections (20%), and febrile neutropenia (14%). Three patients died from disease progression within 30 days after infusion. No deaths were attributed to tisagenlecleucel, cytokine release syndrome, or cerebral edema. No differences between response groups in tumor expression of CD19 or immune checkpoint-related proteins were found.CONCLUSIONS: In this international study of CAR T-cell therapy in relapsed or refractory diffuse large B-cell lymphoma in adults, high rates of durable responses were produced with the use of tisagenlecleucel. (Funded by Novartis; JULIET ClinicalTrials.gov number, NCT02445248 .).
AB - BACKGROUND: Patients with diffuse large B-cell lymphoma that is refractory to primary and second-line therapies or that has relapsed after stem-cell transplantation have a poor prognosis. The chimeric antigen receptor (CAR) T-cell therapy tisagenlecleucel targets and eliminates CD19-expressing B cells and showed efficacy against B-cell lymphomas in a single-center, phase 2a study.METHODS: We conducted an international, phase 2, pivotal study of centrally manufactured tisagenlecleucel involving adult patients with relapsed or refractory diffuse large B-cell lymphoma who were ineligible for or had disease progression after autologous hematopoietic stem-cell transplantation. The primary end point was the best overall response rate (i.e., the percentage of patients who had a complete or partial response), as judged by an independent review committee.RESULTS: A total of 93 patients received an infusion and were included in the evaluation of efficacy. The median time from infusion to data cutoff was 14 months (range, 0.1 to 26). The best overall response rate was 52% (95% confidence interval, 41 to 62); 40% of the patients had complete responses, and 12% had partial responses. Response rates were consistent across prognostic subgroups. At 12 months after the initial response, the rate of relapse-free survival was estimated to be 65% (79% among patients with a complete response). The most common grade 3 or 4 adverse events of special interest included cytokine release syndrome (22%), neurologic events (12%), cytopenias lasting more than 28 days (32%), infections (20%), and febrile neutropenia (14%). Three patients died from disease progression within 30 days after infusion. No deaths were attributed to tisagenlecleucel, cytokine release syndrome, or cerebral edema. No differences between response groups in tumor expression of CD19 or immune checkpoint-related proteins were found.CONCLUSIONS: In this international study of CAR T-cell therapy in relapsed or refractory diffuse large B-cell lymphoma in adults, high rates of durable responses were produced with the use of tisagenlecleucel. (Funded by Novartis; JULIET ClinicalTrials.gov number, NCT02445248 .).
KW - Adult
KW - Aged
KW - Female
KW - Humans
KW - Immunotherapy, Adoptive
KW - Lymphoma, Large B-Cell, Diffuse/mortality
KW - Male
KW - Middle Aged
KW - Neoplasm Grading
KW - Progression-Free Survival
KW - Receptors, Antigen, T-Cell/therapeutic use
KW - Receptors, Chimeric Antigen/therapeutic use
KW - Recurrence
KW - Survival Analysis
KW - Young Adult
UR - http://www.scopus.com/inward/record.url?scp=85058995720&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85058995720&partnerID=8YFLogxK
U2 - 10.1056/NEJMoa1804980
DO - 10.1056/NEJMoa1804980
M3 - Article
C2 - 30501490
AN - SCOPUS:85058995720
SN - 0028-4793
VL - 380
SP - 45
EP - 56
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 1
ER -