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Leo I. Gordon, MD, FACP


ASTRO 2022: Can Bridging Radiotherapy Reduce Toxicity of Immunotherapy for Resistant B-Cell Lymphoma?

By: Kayci Reyer
Posted: Friday, November 4, 2022

According to research presented at the 2022 American Society for Radiation Oncology (ASTRO) Annual Meeting (Abstract 252), bridging radiotherapy may be an effective way to reduce toxicities for some patients with relapsed or refractory aggressive B-cell lymphoma prior to receiving chimeric antigen receptor (CAR) T-cell therapy. Bridging radiotherapy was associated with a low rate of cytokine-release syndrome and immune effector cell–associated neurotoxicity syndrome (ICANS) in patients with a good performance status and bulky tumors.

“An ongoing multi-institutional effort will help refine predictive models for these toxicity endpoints and further elucidate the role of bridging [radiotherapy],” concluded Nikhil Yegya-Raman, MD, of the University of Pennsylvania, Philadelphia, and colleagues.

The single-center, retrospective study included 94 patients with resistant B-cell lymphoma who received treatment with either tisagenlecleucel (n = 66) or axicabtagene ciloleucel (n = 28) between April 2018 and June 2020. Of them, 22 patients (23%) received bridging radiotherapy, whereas the others did not. A total of 68% of the bridging group had an Eastern Cooperative Oncology Group (ECOG) performance status of at least 1 versus 41% in the nonbridging therapy group. The median radiotherapy dose in the bridging therapy group was 31 Gy.

Overall, cytokine-release syndrome occurred at grades 1 (n = 29), 2 (n = 19), and 3 (n = 5), with grade 2 or higher events affecting 4 patients (18%) given bridging therapy and 20 patients (28%) who did not receive such therapy. Grades 1 (n = 11), 2 (n = 6), and 3 (n = 2) of ICANS were also reported, with grade 2 or higher events affecting 1 patient (5%) given bridging therapy and 12 patients (17%) not given such therapy. Both adverse effects were associated with metabolic tumor volume and total lesion glycolysis, and cytokine-release syndrome and ICANS were associated with a largest lesion of at least 5 cm and an ECOG performance status of at least 1, respectively.

Disclosure: Dr. Yegya-Raman reported no conflicts of interest.

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