CAR-HEMATOTOX score to predict risk of poor outcomes with odronextamab in heavily pretreated B-cell non-Hodgkin lymphoma.

The CAR-HEMATOTOX model has been shown to help identify patients with relapsed/refractory (R/R) large B-cell lymphoma (LBCL) at heightened risk of severe neutropenia, serious infection and worse clinical outcomes after chimeric antigen receptor T-cell (CAR-T) therapy. We evaluated whether CAR-HEMATOTOX scores had prognostic value in patients with R/R follicular lymphoma (FL) or diffuse large B-cell lymphoma (DLBCL) treated with odronextamab (cluster of differentiation [CD]20 × CD3 bispecific antibody) in the ELM-1 (NCT02290951) and ELM-2 (NCT03888105) studies. Patients were retrospectively stratified by baseline CAR-HEMATOTOX score: CAR-HEMATOTOX score low (HTlow [0-1]; FL, n = 115, DLBCL, n = 92) or CAR-HEMATOTOX score high (HThigh [≥2]; FL, n = 24, DLBCL, n = 98). The incidence of grade ≥2 cytokine release syndrome within the first 30 treatment days, and rates of grade ≥3 infection and delayed neutrophil recovery within the first 90 treatment days, were numerically higher in HThigh versus HTlow patients. In patients with HThigh versus HTlow scores, progression-free survival (PFS) was significantly poorer in DLBCL (2.6 vs. 9.6 months [p < 0.0001]), and overall survival (OS) was significantly worse in FL and DLBCL (FL, 26.5 months vs. not reached [p = 0.030]; DLBCL, 4.8 vs. 17.2 months [p < 0.0001]). These results suggest that the CAR-HEMATOTOX score may provide a readily available measure for identifying patients at risk of inferior clinical outcomes with odronextamab treatment.