ASH 2024 | The incidence of secondary malignancies in patients with lymphoma receiving CD19-directed CAR-Ts

We use the Medidata clinical trial repository which brings together data from different clinical trials and we looked at patients with lymphoma receiving CD19-directed CAR T-cell therapy and we looked at about 1500 patients in that dataset and wanted to look at the incidence of secondary malignancies which, as you know, has been a hot-button issue in the last year, look at specifically the incidence of T-cell lymphomas, look at that and then look at the cumulative incidence and the timing of those secondary myeloid neoplasms. And so what we found was that the rate per year is about 2.5% per year after CAR T-cell of secondary hematologic malignancies and about 3.5% overall in our population. And in fact, consistent with the fact that we have about just over two years median follow-up, most of those myeloid malignancies are occurring in the first two years after CAR T-cell therapy. And so what we found was that there was only one case of T-cell lymphoma in this dataset. And so this supports the existing data that, in fact, T-cell lymphomas after CAR T-cell therapy are quite rare. Yes, scientifically important, but clinically very uncommon. However, secondary myeloid neoplasms, particularly MDS and AML, were the majority of the secondary hematologic malignancies. And these are, of course, concerning for our patients because they can be life-threatening. And we did find an inferior survival, not surprisingly, among patients with secondary myeloid neoplasms. So I think it supports the existing literature to suggest that the bulk of these secondary hematologic malignancies after CAR T-cell are in fact myeloid malignancies, that the T-cell lymphomas are rare, and that it’s an area of certainly a need for further research.

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