EC Clinical and Medical Case Reports

Background: Chimeric antigen receptor T (CAR-T) cell therapy is an approved, safe and effective therapy for patients with non-Hodgkin’s lymphoma.

Aim: The current study sought to determine if secondary CNS lymphoma patients will safely benefit from CAR T-cell therapy.

Materials and Methods: Two independent raters separately examined PubMed, Web of Science, Embase, and the Cochrane library for all records relating to CAR T-cell therapies (i.e. Axi-cel and Tisa-cel) published prior to May 19, 2022. Included were studies that investigated secondary CNS lymphoma patients treated with CAR T-cell and reported the (Their) effectiveness and safety. Six cohort observational studies were included. A method “(RoB 2.0) tool for observational studies” developed expressly to assess the risk of bias was employed.

Results: Studies were symmetrically distributed, no publication bias. < 20% missing data. (According to current data) CAR-T cell therapy resulted in long-term remission in individuals with secondary CNS lymphoma, according to current data. The results for 872 patients in six trials showed 45 patients with CNS involvement, 827 with no CNS involvement, an ORR in 619 patients (16 of them with CNS involvement) and CR rate in 490 patients (18 with CNS involvement) mean estimate of 73.5% (95% CI, 36.5 ‑ 82%) and 62.5% (95% CI, 39.5 ‑ 64%), respectively. In patients with CNS involvement the CRS “Grade ≥ 3” was 6/45 (30.9%, 21 - 68%) and the ICANS rate was 8/45 (17.7%, 9.8 - 30.2%). The ICU admission was 12/45 (30.31%, 29 - 51%). The progression of the disease/death was reported for 136 patients with BCL from the six selected studies, and reported in one case with CNS involvement. The “progression of the disease/death” pooled “OR” (95% CI) was 14.35% (8.5 - 36.2%).

Conclusion: Patients with secondary CNS lymphoma may benefit from CAR-T cell therapy, with manageable toxicities. As a result, CAR-T cell therapy has the potential to be a therapeutic option for lymphoma patients with CNS involvement. Prospective research with bigger samples and longer follow-up periods are needed.

Keywords: Efficacy; Safety; CAR; T-Cell; Therapies; Lymphoma; Central Nervous System

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