Whole brain radiotherapy combined with CART-cell therapy for relapsed/refractory central nervous system B-cell lymphoma

作者：Hui Shi, Peihao Zheng, Zhonghua Fu, Miaomiao Cao, Fan Yang, Yuelu Guo, Rui Liu, Lixia Ma, Shaomei Feng, Xiuyan Tao, Biping Deng, Lei Yang, Yimeng Dou, Xuenan Zhang, Xiaoyan Ke, Kai Hu · 发表于：Annals of Hematology · 年份：2025 · DOI：10.1007/s00277-025-06378-y · 被引用次数：9 · 研究领域：CNS Lymphoma Diagnosis and Treatment、CAR-T cell therapy research、Lymphoma Diagnosis and Treatment

Relapsed or refractory central nervous system B-cell lymphoma (r/r CNS-BL), including primary central nervous system lymphoma (PCNSL) and secondary central nervous system lymphoma (SCNSL), remains a significant therapeutic challenge with limited treatment options and poor prognosis. This study investigated the combination of whole-brain radiotherapy (WBRT) and chimeric antigen receptor T-cell (CAR-T) therapy in 27 r/r CNS-BL patients. Peripheral blood mononuclear cells were collected before radiotherapy to prepare CAR-T cells. Patients then received whole-brain radiotherapy (WBRT), with or without local boost, followed by CAR-T cell infusion at least one week after radiotherapy completion. Post-CAR-T therapy, the optimal objective response rate (ORR) increased to 88.9%, and the optimal CR rate reached 85.2%. With a median follow-up of 12 months, the median progression-free survival (PFS) and overall survival (OS) were not reached (NR), and the 1-year estimated PFS and OS rate were 61.3% and 56.6%, respectively. Cytokine release syndrome (CRS) occurred in 48.1% of patients. Immune effector cell-associated neurotoxicity syndrome (ICANS) was observed in 29.6% of patients, with only 3.7% on grade 4, all of whom recovered after treatment. This study demonstrates that the combination of WBRT and CAR-T therapy offers a promising therapeutic strategy for r/r CNS-BL patients, improving remission rates and providing a well-tolerated treatment option.