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5131 Statins May Improve Outcomes and Toxicities in Patients Undergoing CD19-Specific CAR T-Cell Therapy for Aggressive B-Cell Lymphomas

Program: Oral and Poster Abstracts
Session: 906. Outcomes Research: Lymphoid Malignancies Excluding Plasma Cell Disorders: Poster III
Hematology Disease Topics & Pathways:
Research, Combination therapy, Clinical Practice (Health Services and Quality), Clinical Research, Health outcomes research, Treatment Considerations, Adverse Events
Monday, December 9, 2024, 6:00 PM-8:00 PM

Shubham Adroja, MBBS1, Ethan A Burns, MD1, Noah Giese, MD, MEng2*, Sunil Mathur1*, Meera Khosla, MD2*, Jacqueline Rios2*, Hala S Hassanain, MD3*, Premal D. Lulla, MBBS4, Carlos A. Ramos, MD2,5, Carrie Yuen, MD1*, Chih-Hang Anthony Tang, MD, PhD6, Chih-Chi Andrew Hu, PhD7, Siddhartha Ganguly, MD2, Helen Elisabeth Heslop8 and Sai Ravi Kiran Pingali, MD1

1Houston Methodist Neal Cancer Center, Houston Methodist Hospital, Houston, TX
2Houston Methodist Hospital, Houston, TX
3Internal Medicine, Department of Academic Medicine, Houston, TX
4Center for Cell and Gene Therapy, Baylor College of Medicine, Houston Methodist Hospital, Texas Children's Hospital, Houston, TX
5Center for Cell and Gene Therapy, Baylor College of Medicine, Houston Methodist Hospital and Texas Children's Hospital, Houston, TX
6Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX
7Houston Methodist Research Institute, Houston, TX
8Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX

Introduction: Statins are both immunomodulatory and anti-inflammatory, and in-vivo studies have demonstrated pro-apoptotic effects in lymphoma cell lines. Moreover, they reduce T-cell exhaustion, which often limits anti-tumor activity and impacts the tumor microenvironment. While statin exposure has been associated with improved outcomes in patients receiving immune check-point inhibitors for solid tumor malignancies, it has not been evaluated in patients undergoing chimeric antigen receptor T-cell (CAR-T) therapy. Herein, we present an analysis of patient outcomes stratified by statin exposure in patients receiving CAR-T therapy targeting CD19 for aggressive B-cell lymphoma.

Methods: Patients diagnosed with aggressive B-cell lymphomas (high grade B-cell lymphoma or diffuse large B-cell lymphoma) who received CD19-CAR-T cells from January 2018 to May 2024 were included. Data was stratified based on statin vs non-statin exposure from time of cell collection to 12 -weeks after CAR-T cell infusion. Demographics, therapy data, treatment toxicities, rescue medications, standard lab parameters, and outcomes data were collected. Median overall survival (OS) and progression free survival (PFS) with 95% confidence interval (CI) were analyzed using Kaplan Meier methodology, and log-rank tests compared survival distributions. P<0.05 was considered statistically significant.

Results: There were 84 patients included, with a median age of 65 (24-78) years. Of these, 34 (40.5%) were females. A total of 32 (38.1%) patients had statin exposure and 52 (61.9%) had no statin exposure. The median ages of statin and non-statin cohorts were 71 (49-78) and 63 (24-77), respectively. Axicabtagene ciloleucel was used in 23 (71.8%) in statin and 42 (80.7%) in non-statin arm. Median prior lines of therapy were 2 (1-4) in both cohorts. Most patients received moderate (59.4%) and high intensity (34.4%) statins.

At last follow-up, 10 (31.2%) patients in the statin group and 22 (42.3%) in non-statin group had progressed, and 7 (21.9%) and 22 (42.3%) patients died, respectively. In the statin and non-statin arms, median PFS was not reached (NR) and 16.7 months (95% CI 4.6, 28.9) (p=0.026), respectively, and median OS was NR vs 17.8 months (95% CI 10.3, 25.3) (p=0.032), respectively.

Cytokine release syndrome (CRS) and immune effector cell neurotoxicity syndrome (ICANS) of any grade were reported in 75.0% and 80.8% (p=0.537) and 21.9% and 34.6% (p=0.220) in the statin and non-statin cohorts, respectively. Median grade CRS was 1 (1-2) and ICANS was 1 (1-2) in both cohorts; utilization of tocilizumab was 43.8% vs 63.5% (p=0.079) and dexamethasone was 40.6% vs 53.8% (p=0.21) in statin and non-statin cohorts, respectively. Inflammatory markers, including ferritin (p=0.256) and CRP (p=0.655), did not significantly differ.

Conclusion: Patients with aggressive B-cell lymphomas and statin exposure along with CD19-CAR-T had a significant improvement in PFS and OS, similar rate of toxicities, and a trend toward lower utilization of tocilizumab. Statin use may enhance efficacy and mitigate toxicities, and its role should be assessed in prospective trials.

Disclosures: Ganguly: Sanofi Genzyme: Consultancy, Honoraria; BMS: Consultancy, Honoraria; Kite Pharma: Consultancy, Honoraria; AstraZeneca: Consultancy, Honoraria.

*signifies non-member of ASH