Incidence of GVHD following anti-CD19 CAR therapy post-HSCT
Ortí G, Peczynski C, Boreland W, et al. Graft-Versus-Host Disease After Anti-CD19 Chimeric Antigen Receptor T-Cell Therapy Following Allogeneic Hematopoietic Cell Transplantation: A Transplant Complications and Paediatric Diseases Working Parties Joint EBMT Study. Leukemia. 2024; (doi: 10.1038/s41375-024-02467-5).
Researchers suspect that concerns about graft-versus-host disease (GVHD) in patients with B-cell malignancies who receive chimeric antigen receptor (CAR) T-cell therapy after allogeneic hematopoietic stem cell transplantation (HSCT) may be overblown. Anti-CD19 CAR therapy is a routine response to post-HSCT relapse, but the unknown safety risks of the CAR T-cells — now likely to originate from transplanted donor T-cells — have been a source of worry. To investigate, study authors used 2018-2022 data from a European HSCT registry to gauge GVHD incidence under these circumstances. The sample included adult and pediatric HSCT patients with B-acute lymphoblastic leukemia or B-non-Hodgkin's lymphoma, with 184 receiving tisagenlecleucel, 43 treated with brexucabtagene autoleucel, and 30 receiving axicabtagene ciloleucel. The analysis revealed a relatively low rate of GVHD, with only three individuals developing acute GVHD (aGVHD) after CAR immunotherapy and six developing chronic GVHD (cGVHD). At 100 days, the cumulative incidence of new aGVHD was 1.6%, while the 12-month cumulative incidence of new chronic cGVHD was 2.8%. Investigators calculated 1-year GVHD relapse-free survival at 52.1%, 1-year non-relapse mortality at 4.7%, and 1-year overall survival at 76.8% — all suggesting GVHD is not a major safety issue for this patient population.