Clinical outcomes of chimeric antigen receptor T cell therapy in 21 patients with Relapse/Refractory Ileocecal Region B cell lymphoma
Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Objective
To evaluate the efficacy, safety, and prognostic factors of chimeric antigen receptor T-cell (CAR-T) therapy in patients with relapsed/refractory ileocecal region lymphoma and provide evidence for salvage therapy.
Methods
A retrospective analysis was conducted on 21 ileocecal region lymphoma patients (IC group) and matched 23 non-ileocecal lymphoma patients (non-IC group) treated with CAR-T therapy between June 2014 and August 2024. Baseline characteristics, genetic mutations (next-generation sequencing), CAR-T cell kinetics (digital PCR), treatment response (WHO criteria), overall survival (OS), and progression-free survival (PFS) were assessed. Kaplan-Meier analysis, Cox regression, and Lasso models were used to identify prognostic factors.
Results
The IC group showed significantly lower 3-month objective response rate (ORR) (55.56% versus 86.96%, P= 0.036) and shorter median PFS (3.5 months versus 27 months, P= 0.0003) compared to the non-IC group, but no OS difference ( P= 0.766). CAR-T cell expansion was higher in the IC group (CD19 C max : 67,290 versus 35,400, P= 0.009), but persistence was similar. TP53 mutations (42.86% in IC group) showed no significant correlation with treatment response. Safety profiles (cytokine release syndrome [CRS] and immune effector cell-associated neurotoxicity syndrome[ICANS]) were comparable between groups ( P >0.05). Multivariate analysis identified poor 3-month treatment response (HR=32.075, P= 0.015) and higher pre-treatment lines (HR=8.6, P= 0.036) as independent risk factors for PFS. Delayed B-cell recovery and low baseline lymphocyte counts were associated with worse OS.
Conclusion
CAR-T therapy is feasible and safe for relapsed/refractory ileocecal lymphoma, but short-term efficacy (ORR, PFS) is inferior to non-ileocecal patients. High CAR-T expansion did not improve long-term outcomes. Early response assessment (3 months), baseline lymphocyte levels, and B-cell recovery are critical prognostic indicators, suggesting the need for optimized timing and combination strategies to enhance efficacy.
