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Posted by on Jan 12, 2018 in Non-Hodgkin lymphoma | 0 comments

In a nutshell

This study looked at the use of axicabtagene ciloleucel (axi-cel) treatment for patients with difficult to treat diffuse large B-cell lymphoma. The study concluded that axi-cel is an effective treatment for diffuse large B-cell lymphoma. 

Some background

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma. Chimeric antigen receptor (CAR) T-cell therapy is a new type of treatment for DLCBL. CAR-T therapy uses modified T-cells. T-cells are a type of white blood cell that is involved in immunity and fighting diseases. T-cells have receptors on the outside of the cell that they use to recognize other cells. These receptors can sense which cells belong to the body (self) and which cells are foreign. The T-cells then signal for the foreign cells to be attacked.

T-cells can be modified to detect different proteins on the surface of other cells. One of these proteins is CD19. CD19 is common on DLBCL cells, but rare on normal body cells. This modification is done with the addition of a chimeric antigen receptor to the T-cells (CAR-T treatment). CAR-T therapy is given after several previous treatments have failed. One type of CAR-T treatment is axi-cel. The treatment is still new and experimental, so much more research is needed on this treatment. 

Methods & findings

111 patients participated in this study. The average length of follow up was 15.4 months. 10 patients were not able to receive axi-cel treatment. Four had negative side effects, 1 was unable to produce CAR-T cells, and 1 died.

The 18-month overall survival rate (time from treatment to death from any cause) was 52%. At 18 months, 40% of patients had no detectable disease (complete response). The average progression free response time (time from treatment to disease progression) was 5.8 months.

The average time from initial treatment to a response to treatment was 1 month.

All patients experienced at least one negative side effect. 95% of patients experienced a side effect that was ranked as grade 3 or higher. 3 patients died due to negative side effects. 78% of patients had a grade 3 or higher neutropenia, a reduction in the number of neutrophils (white blood cells). 28% of patients experienced serious neurological side effects. 

The bottom line

The study concluded that axicabtagene ciloleucel treatment is a safe and effective treatment strategy for patients with refractory diffuse large B-cell lymphoma. 

What’s next?

This treatment has serious side effects, so it is important to talk to your doctor about the benefits and risks of this treatment. 

Published By :

The New England Journal of Medicine

Date :

Dec 10, 2017

Original Title :

Axicabtagene Ciloleucel CAR T-Cell Therapy in Refractory Large B-Cell Lymphoma.

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