ASH 2022 | Novel prognosis score for survival in patients with aggressive lymphoma treated with CAR-T therapy

We have had FDA-approved CD19 CAR-T for patients with aggressive lymphoma for close to five years now, and including in the recent year approval for it’s using earlier lines of indication. So this is very exciting and lots of people are doing studies to better understand predictive markers for patients who would have durable response. And that of course is very important for patients who are going through this still logistically very complex and intense treatment. And also to give us some guidance on how to improve this therapy to hopefully increase even the rate of durable response. We also wanted to look at the other side of the coin, which are, particularly during the covid time, where there may be limitations to hospital capacities and resource restrictions. Are there patients who might be doing so poorly either with CAR-T therapy or any treatment for their disease?

And so a very intense treatment that would not offered the benefit of durable response, should not be considered as much as an option for the patient. So we try to set a pretty stringent mark in looking at our patients treated at Mayo Clinic Rochester, who received FDA-approved CAR-T, and seeing if there are differences in patients who died from any cause within six months of CAR-T treatment as a patient population that probably would not have benefited from being away from home and going through intense treatment versus looking at other goals of care.

And we wanted to identify variables that could be easily accessible in the clinic to help providers look at that information in the context of discussions with the patient. So we looked at a number of different laboratory tests, patient demographics, and identified three simple marks and those are platelet count, absolute lymphocyte counts, and LDH. And so now you could easily see how these labs could be a reflection of either patients underlying lymphoma disease burden or aggressive features or and or potentially comorbidities. And so this may not necessarily be a unique predictive marker for CAR-T therapy.

Nevertheless, for our CAR-T patient population, these were the variables that had essentially more than 70% accuracy in predicting the patients who would die within six months of CAR-T treatment. And so this may be some additional information in the overall assessment of the patients and discussing goals of care and likelihood of benefit for our patient population. Of course, this is a small single-center study and I think multicenter prospective study for such prognostic tools, may have some utility in the practice for CAR-T therapies for our patients.