Article Impact Level: HIGH Data Quality: STRONG Summary of Blood https://doi.org/10.1182/blood-2025-5506 Dr. Helen Gandler et al.
Points
- Researchers analyzed forty-five patients with non-Hodgkin lymphoma to determine if absolute lymphocyte count kinetics could effectively predict clinical outcomes following axicabtagene ciloleucel treatment.
- The study found that patients with a ten-day lymphocyte expansion rate above the median achieved a significantly higher complete response rate of eighty-seven percent compared to fifty-nine percent.
- Data indicated that an absolute lymphocyte count above the median at the time of leukapheresis was significantly associated with prolonged progression-free survival and improved overall survival.
- Patients exhibiting a peak lymphocyte count above the median within thirty days of infusion demonstrated statistically significant improvements in both progression-free and overall survival outcomes.
- These findings suggest that monitoring lymphocyte kinetics offers a readily accessible and cost-effective biomarker strategy for assessing patient response and guiding clinical decision-making in CAR T-cell therapy.
Summary
This retrospective single-center study evaluated the prognostic value of absolute lymphocyte count (ALC) kinetics in 45 patients with relapsed or refractory non-Hodgkin lymphoma (NHL) treated with axicabtagene ciloleucel (axi-cel). Given that most patients relapse despite high initial response rates to chimeric antigen receptor (CAR) T-cell therapy, the research aimed to identify accessible biomarkers for risk stratification. The cohort, with a median age of 63 years, received axi-cel between 2018 and 2023, yielding a median progression-free survival (PFS) of 19.1 months and overall survival (OS) of 22.1 months.
The analysis of post-infusion kinetics revealed that the rate of ALC expansion is a critical determinant of clinical efficacy. Patients with a 10-day ALC expansion rate above the median demonstrated a significantly higher complete response rate (87% vs. 59%; p=0.0472) and prolonged PFS (not reached vs. 34.5 months; p=0.0242). Furthermore, achieving a peak ALC above the median within 30 days of infusion was strongly associated with improved PFS (p=0.0028) and OS (p=0.0031). A time-to-peak ALC of less than 10 days also correlated with superior survival outcomes compared to a delayed peak.
Baseline metrics at the time of leukapheresis also provided significant predictive insight. Patients presenting with an ALC above the median prior to therapy exhibited significantly prolonged PFS (not reached vs. 10.1 months; p=0.0179) and OS (not reached vs. 34.0 months; p=0.0439). Conversely, the ALC/absolute monocyte count ratio showed no association with survival. These findings suggest that ALC kinetics, specifically baseline levels and early expansion rates, serve as robust, low-resource biomarkers for predicting patient responses to axi-cel therapy in NHL.
Link to the article: https://ashpublications.org/blood/article/146/Supplement%201/5506/549796/Lymphocyte-kinetics-as-a-predictor-of-clinical
References
Gandler, H., Khanal, R., Darwish, C., Rao, A., Thomas, R., Shestovska, Y., Vartanov, A., Varshavsky Yanovsky, A., Abdelmessieh, P., Styler, M., Fung, H., & Stack, A. (2025). Lymphocyte kinetics as a predictor of clinical outcomes following CAR-T therapy for non-Hodgkin lymphoma. Blood, 146(Supplement 1), 5506–5506. https://doi.org/10.1182/blood-2025-5506
