Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology · 2025
Bridging radiotherapy for chimeric antigen receptor T cells therapy in non-Hodgkin lymphoma: Systematic review and meta-analysis.
СтатьяМетаанализСистематический обзорНазвание и аннотация: Перевод пока не подготовлен
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Lam Eric Ka-Ming, Luk Mai Yee, Yuen Kwok Keung, Cheung Ben Man-Fei
Аннотация
BACKGROUND AND PURPOSE: Bridging therapy is often needed for relapsed/refractory non-Hodgkin lymphoma (NHL) receiving chimeric antigen receptor T cells (CART) therapy. Bridging radiotherapy (BRT) is often adopted, but its benefit is uncertain. Here, we performed a systematic review and meta-analysis to study the adoption of BRT in CART therapy.
MATERIALS AND METHODS: PubMed, MEDLINE and EMBASE were searched until 13 April 2025 for adult NHL studies adopting BRT before CART therapy. Primary endpoints were 1-year overall survival (OS) and progression-free survival (PFS); secondary endpoints were objective response rate (ORR), in-field failure and grade ≥ 3 cytokine-release syndrome (CRS) or immune effector cell-associated neurotoxicity syndrome (ICANS). Random-effects model was used for pooled estimates. Meta-regression was done to explore clinical covariates.
RESULTS: Fifteen studies including 636 patients were reviewed. Pooled 1-year OS was 67 % and 1-year PFS was 52 %. Pooled ORR was 79 % with complete response rate of 57 %. Pooled in-field failure was 11 %. Pooled Grade ≥ 3 CRS was 5 % while Grade ≥ 3 ICANS was 6 %. Bulky, extra-nodal or advanced-stage disease were associated with worse 1-year OS but not with 1-year PFS nor CART toxicity. Comprehensive BRT covering all lesions was associated with improved 1-year PFS and RT doses > 30 Gy EQD2 was associated with 1-year PFS.
CONCLUSION: BRT leads favourable survival outcome and durable local control while maintaining low rate of severe CRS/ICANS. Comprehensive, adequately dosed irradiation may optimise tumour-burden reduction and improve 1-year PFS. Further prospective studies are warranted to refine RT dose, field coverage and patient selection.
MATERIALS AND METHODS: PubMed, MEDLINE and EMBASE were searched until 13 April 2025 for adult NHL studies adopting BRT before CART therapy. Primary endpoints were 1-year overall survival (OS) and progression-free survival (PFS); secondary endpoints were objective response rate (ORR), in-field failure and grade ≥ 3 cytokine-release syndrome (CRS) or immune effector cell-associated neurotoxicity syndrome (ICANS). Random-effects model was used for pooled estimates. Meta-regression was done to explore clinical covariates.
RESULTS: Fifteen studies including 636 patients were reviewed. Pooled 1-year OS was 67 % and 1-year PFS was 52 %. Pooled ORR was 79 % with complete response rate of 57 %. Pooled in-field failure was 11 %. Pooled Grade ≥ 3 CRS was 5 % while Grade ≥ 3 ICANS was 6 %. Bulky, extra-nodal or advanced-stage disease were associated with worse 1-year OS but not with 1-year PFS nor CART toxicity. Comprehensive BRT covering all lesions was associated with improved 1-year PFS and RT doses > 30 Gy EQD2 was associated with 1-year PFS.
CONCLUSION: BRT leads favourable survival outcome and durable local control while maintaining low rate of severe CRS/ICANS. Comprehensive, adequately dosed irradiation may optimise tumour-burden reduction and improve 1-year PFS. Further prospective studies are warranted to refine RT dose, field coverage and patient selection.