The latest issue of the journal Blood has some updated research on CAR-T in Follicular Lymphoma. The article is called "High rate of durable complete remission in follicular lymphoma after CD19 CAR-T cell immunotherapy."
The article describes results f a phase 1/phase 2 clinical trial involving 21 patients with relapsed/refractory Follicular Lymphoma (13 patients) and transformed Follicular Lymphoma (8 patients). This data comes from a larger trial involving CAR-T and a bunch of different blood cancers.
Patients in the trial were first given a chemo combination -- Cyclophosphamide (the C in CHOP) and Fludarabin. This was done for lymphodepletion -- cutting down on the immune cells in the body. Then they were given the CAR-T (immune cells that had been removed from the patients and changed so they would recognize and destroy cancer cells).
The results were strong -- 88% of the R/R FL patients had a complete response, and all of them remained in remission after a median follow-up of 24 months. For the transformed FL patients, 46% had a complete response, which lasted a median of over 10 months. As fr side effects, 50% of the R/R FL patients had both Cytokine Release Syndrome and nerve issues, while 39% of the transformed patients had CRS and 23% had nerve issues.
The link above only provides an abstract, not the full article, but a commentary about the research was also included, and can be seen for free -- "The case for CAR T-cell therapy in follicular lymphomas."
The commentary adds some interesting information. Other trials (like ZUMA-1 and JULIET) have looked at CAR-T in aggressive lymphomas, so it's hard to compare the results of this trial to them. But the splitting out of R/R FL patients and transformed FL patients is very helpful. We can see that CAR-T can be very effective for patients who continue to need treatment, but who haven't transformed to a more aggressive lymphoma like DLBCL.
The commentary also points out the the chemo given for lymphodepletion was not the same for everyone. Some of the R/R FL patients received more Cyclophosphamidethan others. Perhaps that had an effect, and it's why the R/R numbers were higher than the transformed numbers? Interestingly, the patients in the other CAR-T trials also had differing lymphodepletion amounts. In the JULIET trial, some patients had none at all, and their CR rate was only 29%.
Looking at the title of the commentary, "The case for CAR T-cell therapy in follicular lymphomas," it's easy to see why the author is optimistic. Not every trial results in huge steps forwad, but even s,all steps are important. And maybe something like paying more attention to lymphodepletion strategies will result in a big step.
In the meantime, we can share the author's optimism that CAR-T might seems to have a god and lasting effect for many patients who are R/R, but who aren't transformed. And at some point, maybe we'll see CAR-T available as a first-line treatment as well.
No one is suggesting miracles just yet, but "promise" is a pretty hopeful word.
The commentary adds some interesting information. Other trials (like ZUMA-1 and JULIET) have looked at CAR-T in aggressive lymphomas, so it's hard to compare the results of this trial to them. But the splitting out of R/R FL patients and transformed FL patients is very helpful. We can see that CAR-T can be very effective for patients who continue to need treatment, but who haven't transformed to a more aggressive lymphoma like DLBCL.
The commentary also points out the the chemo given for lymphodepletion was not the same for everyone. Some of the R/R FL patients received more Cyclophosphamidethan others. Perhaps that had an effect, and it's why the R/R numbers were higher than the transformed numbers? Interestingly, the patients in the other CAR-T trials also had differing lymphodepletion amounts. In the JULIET trial, some patients had none at all, and their CR rate was only 29%.
Looking at the title of the commentary, "The case for CAR T-cell therapy in follicular lymphomas," it's easy to see why the author is optimistic. Not every trial results in huge steps forwad, but even s,all steps are important. And maybe something like paying more attention to lymphodepletion strategies will result in a big step.
In the meantime, we can share the author's optimism that CAR-T might seems to have a god and lasting effect for many patients who are R/R, but who aren't transformed. And at some point, maybe we'll see CAR-T available as a first-line treatment as well.
No one is suggesting miracles just yet, but "promise" is a pretty hopeful word.
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