Axicabtagene ciloleucel CAR T-cell therapy in refractory large B-Cell lymphoma

S. S. Neelapu, F. L. Locke, N. L. Bartlett, L. J. Lekakis, D. B. Miklos, C. A. Jacobson, I. Braunschweig, O. O. Oluwole, T. Siddiqi, Y. Lin, J. M. Timmerman, P. J. Stiff, J. W. Friedberg, I. W. Flinn, A. Goy, B. T. Hill, M. R. Smith, A. Deol, U. Farooq, P. McSweeneyJ. Munoz, I. Avivi, J. E. Castro, J. R. Westin, J. C. Chavez, A. Ghobadi, K. V. Komanduri, R. Levy, E. D. Jacobsen, T. E. Witzig, P. Reagan, A. Bot, J. Rossi, L. Navale, Y. Jiang, J. Aycock, M. Elias, D. Chang, J. Wiezorek, W. Y. Go

Research output: Contribution to journalArticle

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Abstract

BACKGROUND In a phase 1 trial, axicabtagene ciloleucel (axi-cel), an autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy, showed efficacy in patients with refractory large B-cell lymphoma after the failure of conventional therapy. METHODS In this multicenter, phase 2 trial, we enrolled 111 patients with diffuse large B-cell lymphoma, primary mediastinal B-cell lymphoma, or transformed follicular lymphoma who had refractory disease despite undergoing recommended prior therapy. Patients received a target dose of 2×106 anti-CD19 CAR T cells per kilogram of body weight after receiving a conditioning regimen of low-dose cyclophosphamide and fludarabine. The primary end point was the rate of objective response (calculated as the combined rates of complete response and partial response). Secondary end points included overall survival, safety, and biomarker assessments. RESULTS Among the 111 patients who were enrolled, axi-cel was successfully manufactured for 110 (99%) and administered to 101 (91%). The objective response rate was 82%, and the complete response rate was 54%.With a median follow-up of 15.4 months, 42% of the patients continued to have a response, with 40% continuing to have a complete response. The overall rate of survival at 18 months was 52%. The most common adverse events of grade 3 or higher during treatment were neutropenia (in 78% of the patients), anemia (in 43%), and thrombocytopenia (in 38%). Grade 3 or higher cytokine release syndrome and neurologic events occurred in 13% and 28% of the patients, respectively. Three of the patients died during treatment. Higher CAR T-cell levels in blood were associated with response. CONCLUSIONS In this multicenter study, patients with refractory large B-cell lymphoma who received CAR T-cell therapy with axi-cel had high levels of durable response, with a safety profile that included myelosuppression, the cytokine release syndrome, and neurologic events.

Original languageEnglish (US)
Pages (from-to)2531-2544
Number of pages14
JournalNew England Journal of Medicine
Volume377
Issue number26
DOIs
StatePublished - Dec 28 2017

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Antigen Receptors
B-Cell Lymphoma
Cell- and Tissue-Based Therapy
CD19 Antigens
Nervous System
Cytokines
T-Lymphocytes
Safety
Follicular Lymphoma
Lymphoma, Large B-Cell, Diffuse
Therapeutics
T-Cell Antigen Receptor
Neutropenia
Thrombocytopenia
Cyclophosphamide
Multicenter Studies
Anemia
Survival Rate
Biomarkers
Body Weight

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Neelapu, S. S., Locke, F. L., Bartlett, N. L., Lekakis, L. J., Miklos, D. B., Jacobson, C. A., ... Go, W. Y. (2017). Axicabtagene ciloleucel CAR T-cell therapy in refractory large B-Cell lymphoma. New England Journal of Medicine, 377(26), 2531-2544. https://doi.org/10.1056/NEJMoa1707447

Axicabtagene ciloleucel CAR T-cell therapy in refractory large B-Cell lymphoma. / Neelapu, S. S.; Locke, F. L.; Bartlett, N. L.; Lekakis, L. J.; Miklos, D. B.; Jacobson, C. A.; Braunschweig, I.; Oluwole, O. O.; Siddiqi, T.; Lin, Y.; Timmerman, J. M.; Stiff, P. J.; Friedberg, J. W.; Flinn, I. W.; Goy, A.; Hill, B. T.; Smith, M. R.; Deol, A.; Farooq, U.; McSweeney, P.; Munoz, J.; Avivi, I.; Castro, J. E.; Westin, J. R.; Chavez, J. C.; Ghobadi, A.; Komanduri, K. V.; Levy, R.; Jacobsen, E. D.; Witzig, T. E.; Reagan, P.; Bot, A.; Rossi, J.; Navale, L.; Jiang, Y.; Aycock, J.; Elias, M.; Chang, D.; Wiezorek, J.; Go, W. Y.

In: New England Journal of Medicine, Vol. 377, No. 26, 28.12.2017, p. 2531-2544.

Research output: Contribution to journalArticle

Neelapu, SS, Locke, FL, Bartlett, NL, Lekakis, LJ, Miklos, DB, Jacobson, CA, Braunschweig, I, Oluwole, OO, Siddiqi, T, Lin, Y, Timmerman, JM, Stiff, PJ, Friedberg, JW, Flinn, IW, Goy, A, Hill, BT, Smith, MR, Deol, A, Farooq, U, McSweeney, P, Munoz, J, Avivi, I, Castro, JE, Westin, JR, Chavez, JC, Ghobadi, A, Komanduri, KV, Levy, R, Jacobsen, ED, Witzig, TE, Reagan, P, Bot, A, Rossi, J, Navale, L, Jiang, Y, Aycock, J, Elias, M, Chang, D, Wiezorek, J & Go, WY 2017, 'Axicabtagene ciloleucel CAR T-cell therapy in refractory large B-Cell lymphoma', New England Journal of Medicine, vol. 377, no. 26, pp. 2531-2544. https://doi.org/10.1056/NEJMoa1707447
Neelapu, S. S. ; Locke, F. L. ; Bartlett, N. L. ; Lekakis, L. J. ; Miklos, D. B. ; Jacobson, C. A. ; Braunschweig, I. ; Oluwole, O. O. ; Siddiqi, T. ; Lin, Y. ; Timmerman, J. M. ; Stiff, P. J. ; Friedberg, J. W. ; Flinn, I. W. ; Goy, A. ; Hill, B. T. ; Smith, M. R. ; Deol, A. ; Farooq, U. ; McSweeney, P. ; Munoz, J. ; Avivi, I. ; Castro, J. E. ; Westin, J. R. ; Chavez, J. C. ; Ghobadi, A. ; Komanduri, K. V. ; Levy, R. ; Jacobsen, E. D. ; Witzig, T. E. ; Reagan, P. ; Bot, A. ; Rossi, J. ; Navale, L. ; Jiang, Y. ; Aycock, J. ; Elias, M. ; Chang, D. ; Wiezorek, J. ; Go, W. Y. / Axicabtagene ciloleucel CAR T-cell therapy in refractory large B-Cell lymphoma. In: New England Journal of Medicine. 2017 ; Vol. 377, No. 26. pp. 2531-2544.
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abstract = "BACKGROUND In a phase 1 trial, axicabtagene ciloleucel (axi-cel), an autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy, showed efficacy in patients with refractory large B-cell lymphoma after the failure of conventional therapy. METHODS In this multicenter, phase 2 trial, we enrolled 111 patients with diffuse large B-cell lymphoma, primary mediastinal B-cell lymphoma, or transformed follicular lymphoma who had refractory disease despite undergoing recommended prior therapy. Patients received a target dose of 2×106 anti-CD19 CAR T cells per kilogram of body weight after receiving a conditioning regimen of low-dose cyclophosphamide and fludarabine. The primary end point was the rate of objective response (calculated as the combined rates of complete response and partial response). Secondary end points included overall survival, safety, and biomarker assessments. RESULTS Among the 111 patients who were enrolled, axi-cel was successfully manufactured for 110 (99{\%}) and administered to 101 (91{\%}). The objective response rate was 82{\%}, and the complete response rate was 54{\%}.With a median follow-up of 15.4 months, 42{\%} of the patients continued to have a response, with 40{\%} continuing to have a complete response. The overall rate of survival at 18 months was 52{\%}. The most common adverse events of grade 3 or higher during treatment were neutropenia (in 78{\%} of the patients), anemia (in 43{\%}), and thrombocytopenia (in 38{\%}). Grade 3 or higher cytokine release syndrome and neurologic events occurred in 13{\%} and 28{\%} of the patients, respectively. Three of the patients died during treatment. Higher CAR T-cell levels in blood were associated with response. CONCLUSIONS In this multicenter study, patients with refractory large B-cell lymphoma who received CAR T-cell therapy with axi-cel had high levels of durable response, with a safety profile that included myelosuppression, the cytokine release syndrome, and neurologic events.",
author = "Neelapu, {S. S.} and Locke, {F. L.} and Bartlett, {N. L.} and Lekakis, {L. J.} and Miklos, {D. B.} and Jacobson, {C. A.} and I. Braunschweig and Oluwole, {O. O.} and T. Siddiqi and Y. Lin and Timmerman, {J. M.} and Stiff, {P. J.} and Friedberg, {J. W.} and Flinn, {I. W.} and A. Goy and Hill, {B. T.} and Smith, {M. R.} and A. Deol and U. Farooq and P. McSweeney and J. Munoz and I. Avivi and Castro, {J. E.} and Westin, {J. R.} and Chavez, {J. C.} and A. Ghobadi and Komanduri, {K. V.} and R. Levy and Jacobsen, {E. D.} and Witzig, {T. E.} and P. Reagan and A. Bot and J. Rossi and L. Navale and Y. Jiang and J. Aycock and M. Elias and D. Chang and J. Wiezorek and Go, {W. Y.}",
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TY - JOUR

T1 - Axicabtagene ciloleucel CAR T-cell therapy in refractory large B-Cell lymphoma

AU - Neelapu, S. S.

AU - Locke, F. L.

AU - Bartlett, N. L.

AU - Lekakis, L. J.

AU - Miklos, D. B.

AU - Jacobson, C. A.

AU - Braunschweig, I.

AU - Oluwole, O. O.

AU - Siddiqi, T.

AU - Lin, Y.

AU - Timmerman, J. M.

AU - Stiff, P. J.

AU - Friedberg, J. W.

AU - Flinn, I. W.

AU - Goy, A.

AU - Hill, B. T.

AU - Smith, M. R.

AU - Deol, A.

AU - Farooq, U.

AU - McSweeney, P.

AU - Munoz, J.

AU - Avivi, I.

AU - Castro, J. E.

AU - Westin, J. R.

AU - Chavez, J. C.

AU - Ghobadi, A.

AU - Komanduri, K. V.

AU - Levy, R.

AU - Jacobsen, E. D.

AU - Witzig, T. E.

AU - Reagan, P.

AU - Bot, A.

AU - Rossi, J.

AU - Navale, L.

AU - Jiang, Y.

AU - Aycock, J.

AU - Elias, M.

AU - Chang, D.

AU - Wiezorek, J.

AU - Go, W. Y.

PY - 2017/12/28

Y1 - 2017/12/28

N2 - BACKGROUND In a phase 1 trial, axicabtagene ciloleucel (axi-cel), an autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy, showed efficacy in patients with refractory large B-cell lymphoma after the failure of conventional therapy. METHODS In this multicenter, phase 2 trial, we enrolled 111 patients with diffuse large B-cell lymphoma, primary mediastinal B-cell lymphoma, or transformed follicular lymphoma who had refractory disease despite undergoing recommended prior therapy. Patients received a target dose of 2×106 anti-CD19 CAR T cells per kilogram of body weight after receiving a conditioning regimen of low-dose cyclophosphamide and fludarabine. The primary end point was the rate of objective response (calculated as the combined rates of complete response and partial response). Secondary end points included overall survival, safety, and biomarker assessments. RESULTS Among the 111 patients who were enrolled, axi-cel was successfully manufactured for 110 (99%) and administered to 101 (91%). The objective response rate was 82%, and the complete response rate was 54%.With a median follow-up of 15.4 months, 42% of the patients continued to have a response, with 40% continuing to have a complete response. The overall rate of survival at 18 months was 52%. The most common adverse events of grade 3 or higher during treatment were neutropenia (in 78% of the patients), anemia (in 43%), and thrombocytopenia (in 38%). Grade 3 or higher cytokine release syndrome and neurologic events occurred in 13% and 28% of the patients, respectively. Three of the patients died during treatment. Higher CAR T-cell levels in blood were associated with response. CONCLUSIONS In this multicenter study, patients with refractory large B-cell lymphoma who received CAR T-cell therapy with axi-cel had high levels of durable response, with a safety profile that included myelosuppression, the cytokine release syndrome, and neurologic events.

AB - BACKGROUND In a phase 1 trial, axicabtagene ciloleucel (axi-cel), an autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy, showed efficacy in patients with refractory large B-cell lymphoma after the failure of conventional therapy. METHODS In this multicenter, phase 2 trial, we enrolled 111 patients with diffuse large B-cell lymphoma, primary mediastinal B-cell lymphoma, or transformed follicular lymphoma who had refractory disease despite undergoing recommended prior therapy. Patients received a target dose of 2×106 anti-CD19 CAR T cells per kilogram of body weight after receiving a conditioning regimen of low-dose cyclophosphamide and fludarabine. The primary end point was the rate of objective response (calculated as the combined rates of complete response and partial response). Secondary end points included overall survival, safety, and biomarker assessments. RESULTS Among the 111 patients who were enrolled, axi-cel was successfully manufactured for 110 (99%) and administered to 101 (91%). The objective response rate was 82%, and the complete response rate was 54%.With a median follow-up of 15.4 months, 42% of the patients continued to have a response, with 40% continuing to have a complete response. The overall rate of survival at 18 months was 52%. The most common adverse events of grade 3 or higher during treatment were neutropenia (in 78% of the patients), anemia (in 43%), and thrombocytopenia (in 38%). Grade 3 or higher cytokine release syndrome and neurologic events occurred in 13% and 28% of the patients, respectively. Three of the patients died during treatment. Higher CAR T-cell levels in blood were associated with response. CONCLUSIONS In this multicenter study, patients with refractory large B-cell lymphoma who received CAR T-cell therapy with axi-cel had high levels of durable response, with a safety profile that included myelosuppression, the cytokine release syndrome, and neurologic events.

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U2 - 10.1056/NEJMoa1707447

DO - 10.1056/NEJMoa1707447

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JO - New England Journal of Medicine

JF - New England Journal of Medicine

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