https://orcid.org/0000-0002-5658-1831
Key Points
CAR transgene levels in blood may be associated with long-term responses but may not predict the relapses in B-ALL and DLBCL
In DLBCL, B-cell recovery was not associated with relapse, while in B-ALL, responses were maintained despite late B-cell recovery(>6 months)
Tisagenlecleucel is a CD19-directed autologous chimeric antigen receptor (CAR) T-cell therapy. Quantitative polymerase chain reaction assays are highly sensitive in defining in vivo kinetics by measuring CAR transgene in peripheral blood. This study aimed to identify clinically meaningful CAR T-cell blood levels that correlated with response/relapse. In pediatric/young adult patients with relapsed/refractory (r/r) B-cell acute lymphoblastic leukemia (B-ALL), maximum CAR T-cell blood levels were higher in patients with ongoing complete remission and in patients with CD19(−) relapse relative to those with CD19(+) relapse. In adult patients with r/r diffuse large B-cell lymphoma (DLBCL), no apparent association between in vivo kinetics and response was noted, with a wide range of transgene levels at relapse. In B-ALL, patients with B-cell aplasia sustained beyond 6 months had higher CAR T-cell expansion relative to those with early B-cell recovery (BCR) (<6 months post-infusion); however, a definitive cut-off for BCR-associated expansion level could not be identified. In most patients with B-ALL, BCR >6 months maintained favorable responses. However, early BCR could not be confirmed as a potential indicator of relapse due to high censoring from transplantation, following presumed risk of relapse. However, allo-grafting these patients may potentially mitigate the poor prognosis related to early BCR. In DLBCL, BCR was not associated with relapse. These findings suggest that blood CAR transgene levels may be associated with long-term responses; however, lack robust predictive potential for relapses. As reported earlier, next-generation sequencing for minimal residual disease appears to be a reliable biomarker predictive of relapse for B-ALL. ELIANA (NCT02435849), ENSIGN (NCT02228096) and JULIET (NCT02445248)
