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Abstract Details

CAR T Cells in Primary and Secondary CNS Lymphoma
Neuro-oncology
S27 - Neuro-oncology (3:54 PM-4:06 PM)
003
Chimeric antigen receptor (CAR) T-cells targeting CD19 have been established as a leading T-cell therapy for systemic B-cell lymphomas; however, data for patients with CNS involvement from systemic disease or primary CNS lymphoma are limited.
To assess the efficacy and tolerability of CAR-T cells in primary and secondary CNS lymphoma.
Retrospective analysis of patients treated with CAR-T cells for primary and secondary CNS lymphoma. Clinical data, CNS-specific toxicities, imaging findings, and outcomes were analyzed.

We report our experiences from a total of 45 consecutive CAR T-cell transfusions in patients with active primary or secondary CNS lymphoma at the Massachusetts General Hospital. This cohort includes 17 patients treated for primary CNS lymphoma (PCNSL; one patient with two CAR T-cell transfusions) and 27 patients treated for secondary CNS lymphoma (SCNSL). Mild neurotoxicity (grade 1-2) was observed after 19/45 transfusions (42.2%) and severe neurotoxicity (grade 3-4) after 7/45 transfusions (15.6%). A larger increase in C-reactive protein (CRP) levels and higher rates of neurotoxicity were detected in SCNSL. Early fever and baseline CRP levels predicted neurotoxicity occurrence. CNS response was seen in 31 cases (68.9%), including complete responses of CNS disease in 18 cases (40.0%), lasting for a median of 11.4 ± 4.5 months. Dexamethasone dose at time of lymphodepletion (but not at or after CAR T-cell transfusion) was associated with an increased risk for CNS progression (HR per mg/d: 1.16, = 0.031). If bridging therapy was warranted, the use of Ibrutinib translated into a favorable CNS-progression free survival (5 versus 1 month, HR 0.28, CI 0.1-0.7; = 0.010).

CD19-directed CAR T-cells exhibit promising anti-tumor effects and a favorable safety profile in patients with primary and secondary CNS lymphoma. Further evaluation on the optimal bridging regimens prior to CAR-T cells and corticosteroid use is warranted.

Authors/Disclosures
Jorg Dietrich (Massachusetts General Hospital, Harvard Medical School)
PRESENTER
Dr. Dietrich has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. Dr. Dietrich has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Dietrich has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ono Therapeutics. Dr. Dietrich has received publishing royalties from a publication relating to health care.
Isabel Arrillaga-Romany (Mass General Hospital) Dr. Arrillaga-Romany has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Boehringer Ingelheim. The institution of Dr. Arrillaga-Romany has received research support from Astex Pharmaceuticals. The institution of Dr. Arrillaga-Romany has received research support from Gsk.
April Eichler (Massachusetts General Hospital) Dr. Eichler has received personal compensation for serving as an employee of Wolters Kluwer Health, UpToDate. An immediate family member of Dr. Eichler has stock in Swan Bio. An immediate family member of Dr. Eichler has received publishing royalties from a publication relating to health care.
Deborah Forst Dr. Forst has stock in Eli Lilly. Dr. Forst has received research support from Conquer Cancer Foundation of the American Society of Clinical Oncology. Dr. Forst has received research support from Palliative Care Research Cooperative Group. Dr. Forst has received research support from American Cancer Society Institutional Research Grant.
Elizabeth Gerstner Dr. Gerstner has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Midatech. Dr. Gerstner has received personal compensation in the range of $50,000-$99,999 for serving as an officer or member of the Board of Directors for Gerstner Family Foundation. The institution of Dr. Gerstner has received research support from NCI.
Justin Jordan (Massachusetts General Hospital) Dr. Jordan has received personal compensation for serving as an employee of City of Beverly. An immediate family member of Dr. Jordan has received personal compensation for serving as an employee of Dietitians on Demand. An immediate family member of Dr. Jordan has received personal compensation for serving as an employee of Genesis HR Solutions. An immediate family member of Dr. Jordan has received personal compensation for serving as an employee of Harborlight Montesorri. Dr. Jordan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Navio Theragnostics. Dr. Jordan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Recursion Pharmaceuticals, Inc. Dr. Jordan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BCD Meetings. Dr. Jordan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Shepherd Therapeutics. Dr. Jordan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion Pharmaceuticals. Dr. Jordan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Akeila Bio. Dr. Jordan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Springworks Therapeutics. Dr. Jordan has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Continental Casualty Company. Dr. Jordan has stock in Navio Theragnostics. Dr. Jordan has stock in The Doctor Lounge. An immediate family member of Dr. Jordan has stock in OldGate. Dr. Jordan has stock in Akeila Bio. The institution of Dr. Jordan has received research support from NIH. The institution of Dr. Jordan has received research support from Department of Defense. The institution of Dr. Jordan has received research support from PCORI. Dr. Jordan has received publishing royalties from a publication relating to health care. Dr. Jordan has received personal compensation in the range of $500-$4,999 for serving as a Reimbursement for potential consultant role that was aborted with Magnet Biomedicine. Dr. Jordan has a non-compensated relationship as a board member with United Council for Neurologic Subspecialties that is relevant to AAN interests or activities.
Ina Ly (Pappas Center for Neuro-Oncology) An immediate family member of Dr. Ly has received personal compensation for serving as an employee of Enanta Pharmaceuticals. Dr. Ly has received research support from Department of Defense. An immediate family member of Dr. Ly has received intellectual property interests from a discovery or technology relating to health care.
Scott Plotkin (Mass General Cancer Center) Dr. Plotkin has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for NFlection Therapeutics. Dr. Plotkin has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Akouos. Dr. Plotkin has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for SonALAsense. Dr. Plotkin has stock in NFlection Therapeutics. Dr. Plotkin has stock in NF2 Therapeutics. Dr. Plotkin has stock in SonALAsense. Dr. Plotkin has received research support from Children's Tumor Foundation. Dr. Plotkin has received research support from Department of Defense. Dr. Plotkin has received research support from National Institutes of Health. Dr. Plotkin has received intellectual property interests from a discovery or technology relating to health care.
Nancy Wang (Stephen E.Catherine Pappas Center for Neuro-Oncology) Dr. Wang has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Seattle Genetics. The institution of Dr. Wang has received research support from Merck. Dr. Wang has received publishing royalties from a publication relating to health care.
Maria Martinez-Lage (Massachusetts General Hospital) The institution of Dr. Martinez-Lage has received research support from NIH.
Sebastian Friedrich Winter (MGH Cancer Center) Mr. Winter has nothing to disclose.
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Daniel Cahill (MGH Cancer Center) Daniel P. Cahill, MD, PhD has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Advise Connect Inspire. Daniel P. Cahill, MD, PhD has received personal compensation in the range of $0-$499 for serving as a Consultant for German Accelerator. Daniel P. Cahill, MD, PhD has received personal compensation in the range of $0-$499 for serving as a Consultant for Incephalo. Daniel P. Cahill, MD, PhD has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Boston Scientific.
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Philipp Karschnia Philipp Karschnia has nothing to disclose.