Bridging therapy with axicabtagene ciloleucel for large B-cell lymphoma: Results from the US lymphoma CAR-T consortium.

During the manufacturing period of autologous chimeric antigen receptor (CAR) T cell therapy, patients may experience a decline in their condition due to cancer progression. In this study, we investigated the impact of "bridging therapy" (BT) on the outcome of patients with relapsed/refractory large B cell lymphoma who received anti-lymphoma treatment between leukapheresis and axicabtagene ciloleucel (axi-cel) infusion. We conducted our analysis using data from the multicenter US Lymphoma CAR T Consortium, with a median follow-up of 33 months (range: 4.3-42.1). Out of the 298 patients who underwent leukapheresis, 275 patients received axi-cel. The 52% (n=143) of patients who received BT had a higher baseline risk profile compared to patients who did not receive BT and these patients as a group had inferior outcomes than those who did not have BT. However, after propensity score matching between the two groups, there was no statistically significant differences in ORR (77% vs 87%, p=0.13), CR rate (58% vs 70%, p=0.1), PFS (HR=1.25, p=0.23), and OS (HR=1.39, p=0.09) between BT group and no BT group respectively. Analyzing effects of BT in the whole leukapheresed cohort regardless of receiving axi-cel (intention to treat analysis) showed similar results. Bridging radiation therapy resulted in outcomes similar to those observed with non-radiation BT. Our findings suggest that BT may be safe without a significant impact on long-term survival in patients who require disease stabilization during the manufacturing period. Moreover, our results suggest that there is no clear advantage in using radiation-based BT over non-radiation-based BT.