Study Validates Safety and Effectiveness of Cell Therapy in Lymphoma Remission

A recent investigation explores the effectiveness of CAR T immunotherapy in individuals who achieved lymphoma remission prior to the infusion.

Many patients undergoing cell therapy, an immunotherapy variant utilizing engineered immune cells to target and combat the patient’s cancer, find it to be a crucial intervention, often sought after when other treatment modalities prove ineffective.

Within his practice at Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine, Dr. Trent Wang, a hematologist and cellular therapy specialist, observed a peculiar occurrence in recent years while administering this therapy to lymphoma patients: some individuals attained complete remission before the infused cells made contact with their bodies.

Dr. Wang is sharing the findings of a study focusing on lymphoma patients who underwent cell therapy during their remission phase at the annual meeting of the American Society of Hematology in San Diego.

Navigating Treatment Challenges

This unusual scenario unfolds in the lead-up to cell therapy, a procedure explored in Dr. Wang’s study involving the utilization of a specialized engineered immune cell called CAR T cells. Once the patient initiates the process, a waiting period of three to five weeks ensues before the actual treatment is administered. Securing insurance approval becomes a prerequisite, and the cells themselves must be manufactured from the patient’s own cells. However, a considerable number of these patients grapple with severe cancer-related symptoms, prompting physicians to often opt for a brief course of chemotherapy or alternative drugs to alleviate these manifestations.

During this interim treatment period, a small subset of patients achieves remission, as observed by the clinicians.

“That prompted this dilemma: Now what are we supposed to do?” Dr. Wang said. “Should we change the plan or give the therapy anyway? We just didn’t have a lot of information on this scenario.”

Dr. Wang acknowledged that, more frequently than not, his team proceeds with cell therapy in these instances, primarily to avert the risk of the cancer resurfacing during an extended waiting period. Nevertheless, the decision-making process doesn’t always feel well-informed.

A Nationwide Inquiry

At Sylvester, Dr. Wang and his team observed positive outcomes in patients who underwent cell therapy while in lymphoma remission. However, uncertainty lingered about the generalizability of these findings to a larger cohort. To address this, they proposed a research study to the Center for International Blood & Marrow Transplant Research, a nationwide registry monitoring patients who have undergone transplants or cell therapies.

The study encompassed data from 134 patients in the registry who achieved complete remission during the waiting period before receiving cell therapy. To identify this subset, the scientists scrutinized the records of over 5,000 cell therapy patients.

Results revealed that this patient group exhibited a 43% probability of progression-free survival over the two years following treatment, comparable to patients in the registry who did not experience remission before CAR T-cell therapy. Notably, those in remission displayed minimal toxicities associated with cell therapies, specifically lower levels of cytokine release syndrome and neurotoxicity—immune overreaction side effects occasionally linked with CAR T-cell therapy.

Dr. Wang clarified that the study utilized data from patients treated with CAR T-cell therapy from 2015 to 2021, and the current frequencies of specific cell therapy usage may differ from those employed in practice a few years ago. The researchers aim to investigate data aligning with more recent treatment trends in subsequent studies.

Although the study doesn’t definitively answer the question of whether cell therapy during remission is the optimal choice, it does assert that it is not an incorrect decision.

“I don’t think it answers the question of: Should we give these patients cell therapy?” Dr. Wang said. “But I think it answers the question that we can—that it’s safe and that it’s a reasonable strategy when you’re in that spot.”

Source: University of Miami Miller School of Medicine