Bridging therapy prior to axicabtagene ciloleucel for relapsed/refractory large B-cell lymphoma

The impact of bridging therapy (BT) administered between leukapheresis and chimeric antigen receptor (CAR) T-cell therapy for large B-cell lymphoma (LBCL) is unclear. We evaluated the influence of BT (systemic therapy [ST], radiation therapy [RT], or combinedmodality therapy [CMT]) on outcomes of 148 LBCL patients who underwent leukapheresis for planned axicabtagene ciloleucel (axi-cel) infusion. The 55% (n 5 81) of patients who received BT were more likely to have international prognostic index (IPI) score $3 (P # .01), bulky disease (P 5 .01), and elevated lactate dehydrogenase (LDH; P # .01). The 1-year progression-free (PFS) and overall survival (OS) rates were 40% and 65% in non-BT patients vs 21% and 48% in BT patients (P 5 .01 and .05, respectively). Twenty-four patients (16%) did not receive axi-cel, most commonly because of lymphoma progression (88%), despite 80% (n 5 19) receiving BT. Among 124 patients who received axi-cel, 50% (n 5 62) received BT with ST (n 5 45), RT (n 5 11), or CMT (n 5 6); 1-year PFS and OS rates were not significantly different between BT and non-BT cohorts (P 5 .06 and .21, respectively). There was no difference in proportion of patients with IPI $3, limited-stage disease, or elevated LDH between ST, RT, and CMT groups. Compared with non-BT patients, 1-year PFS was inferior for ST-bridged patients (P 5 .01). RT-bridged patients had improved PFS compared with ST-bridged patients (P 5 .05). Despite the poor prognosis associated with requiring BT, RT can be an effective bridging strategy. Future studies are necessary to identify strategies that may improve access to CAR T-cell therapy and outcomes.