Predictive Value of CIRS-Derived Comorbidity Index for Patients With R/R DLBCL Indicated for CAR T-Cell Therapy
According to a retrospective analysis published in Blood Advances, a simplified cumulative illness rating scale (CIRS)-derived comorbidity index was able to assess and predict adverse outcomes among patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) indicated for chimeric antigen receptor T-cell (CAR T) therapy.
Although CAR T has demonstrated promising survival outcomes among patients with R/R DLBCL, “limited durability of response and prevalent toxicities remain problematic,” Geoffrey Shouse, DO, MPH, City of Hope National Medical Center, Duarte, California, and coauthors stated.
“Identifying patients who are at high risk of disease progression, toxicity, and death would inform treatment decisions,” they added. While the CIRS has demonstrated correlations with survival outcomes among patients with B-cell malignancies, the validation of prognostic scoring in the context of CAR T has not been explored.
To fill this gap in research, the study authors identified 577 patients with R/R DLBCL indicated for CAR T in this retrospective study, which formed a learning cohort. Overall survival (OS) and progression-free survival (PFS) were observed using survival forest modeling to determine the most influential CIRS organ systems and their corresponding severity grades.
Notably, severe comorbidities (CIRS score ≥ 3) in the respiratory, upper gastrointestinal, hepatic, or renal system, which they named “Severe4,” had the most influence on post-CART PFS and overall survival in the learning cohort and in the independent single-center validation cohort. This finding remained consistent after adjustment for other prognostic factors, such as the prior number of therapies, Eastern Cooperative Oncology Group (ECOG) performance status, BCL6 translocation, and molecular subtype. “Severe4” also significantly predicted grade ≥3 cytokine release syndrome among the learning cohort, as well as across the validation cohort.
Dr Shouse et al concluded, “Adverse outcomes for patients with DLBCL meant to receive CAR T can be predicted using a simplified CIRS-derived comorbidity index.”
Source:
Shouse G, Kaempf A, Gordon MJ, et al; A validated composite comorbidity index predicts outcomes of CAR T-cell therapy in patients with diffuse large B-cell lymphoma. Blood Adv 2023; 7 (14): 3516–3529. doi:10.1182/bloodadvances.2022009309
