Extranodal (EN) diffuse large B-cell lymphoma (DLBCL) has been historically associated with inferior survival outcomes compared to nodal DLBCL. However, outcomes of patients with EN DLBCL following chimeric antigen receptor T-cell (CAR-T) therapy are not well established. In this multi-center retrospective cohort study, we evaluated the outcomes of patients with EN DLBCL who underwent CAR-T in the relapsed/refractory (R/R) setting. The primary objective was overall survival (OS), while secondary objectives included progression-free survival (PFS), response rates, and toxicity rates. A total of 218 patients were included in the analysis. The most common sites of EN involvement were skin/soft tissue (25%), bone (22%), and lung (17%). Overall response rate (ORR) and complete response rate (CRR) at first post-treatment evaluation were 62% (n = 127) and 40% (n = 82), respectively. Median follow-up was 3.5 years. Median PFS and OS were 4.0 months (95% CI = 3.1–7.2) and 25.7 months (95% CI = 16.1–51.6), respectively. Cytokine release syndrome (CRS) of any grade occurred in 73% (n = 159) of patients, and 6% (n = 12) had grade ≥ 3 CRS. Immune effector cell-associated neurotoxicity syndrome (ICANS) of any grade occurred in 37% (n = 81) of patients, and 19% (n = 41) developed grade ≥ 3 ICANS. In the multivariable analysis, factors that were independently prognostic of inferior OS were 3 or more lines of therapy prior to CAR-T, bulky disease at the time of CAR-T, hepatobiliary, and pancreas involvement, while refractory disease to the most recent therapy prior to CAR-T was associated with inferior PFS. Future studies should further evaluate outcomes of CAR-T in patients with specific EN sites of involvement that appear to be associated with inferior survival such as the liver and pancreas.
与淋巴结弥漫大B细胞淋巴瘤相比，结外弥漫大B细胞淋巴瘤在历史上一直与较差的生存结局相关。然而，接受嵌合抗原受体T细胞疗法治疗的结外弥漫大B细胞淋巴瘤患者的预后尚未明确。在这项多中心回顾性队列研究中，我们评估了复发/难治性结外弥漫大B细胞淋巴瘤患者接受CAR-T治疗后的结局。主要研究终点是总生存期，次要终点包括无进展生存期、缓解率及毒性反应发生率。分析共纳入218例患者。最常见的结外受累部位为皮肤/软组织、骨骼和肺部，分别占25%、22%和17%。首次治疗后评估的总体缓解率和完全缓解率分别为62%和40%。中位随访时间为3.5年。中位无进展生存期和总生存期分别为4.0个月和25.7个月。任何级别的细胞因子释放综合征发生率为73%，其中≥3级占6%；任何级别的免疫效应细胞相关神经毒性综合征发生率为37%，其中≥3级占19%。多变量分析显示，CAR-T治疗前接受过≥3线治疗、CAR-T时存在大包块病变、肝胆胰受累是总生存期较差的独立预后因素，而CAR-T前对最近期治疗耐药与较差的无进展生存期相关。未来研究应进一步评估CAR-T在特定结外受累部位（如肝脏和胰腺等与较差生存相关的部位）患者中的疗效。
肿瘤(癌症)患者之家