[Efficacy and safety analysis of the salvage treatment for diffuse large B-cell lymphoma after the failure of anti-CD19 CAR-T therapy].

Abstract

Objective: To evaluate the efficacy and safety of the salvage treatment in patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) who failed prior anti-CD19 chimeric antigen receptor T-cell (CAR-T) therapy. Methods: This study retrospectively analyzed clinical data of 23 patients with DLBCL who failed CD19 CAR-T therapy at the Department of Hematology, Tongji Hospital, from March 2022 to March 2026. Patients were divided into the anti-CD20 T-cell immunotherapy group (n=12) and non-anti-CD20 T-cell immunotherapy group (n=11). Efficacy and safety were compared between the two groups. Results: This study included 23 patients. With a median follow-up of 13.5 (95% CI: 10.4-31.9) months, the overall response rate (ORR) was 60.8% (14/23), and 11 (47.8%) patients achieved complete remission (CR). Median progression-free survival (PFS) and overall survival (OS) were not reached. In the anti-CD20 T-cell immunotherapy group, ORR was 100% with a CR rate of 91.7%, and the median PFS and OS were not reached. In the non-anti-CD20 T-cell immunotherapy group, ORR was 18.2% (95% CI: 2.3%-51.8%) with only two partial responses, and the median PFS and OS were 1.7 and 2.6 months, respectively (P<0.001 for both). Regarding safety, 10 (83.3%) patients in the T-cell immunotherapy group developed grade 1-2 cytokine release syndrome, and no immune effector cell-associated neurotoxicity syndrome occurred. In the non-anti-CD20 T-cell immunotherapy group, the main adverse events were hematologic toxicities. Conclusion: Anti-CD20 T-cell immunotherapy yields significantly higher response rates and longer survival compared with non-anti-CD20 T-cell immunotherapy in patients with DLBCL failing anti-CD19 CAR-T therapy, with a manageable safety profile.