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Supplementary Figures S1-S16 from Product Attributes of CAR T-cell Therapy Differentially Associate with Efficacy and Toxicity in Second-line Large B-cell Lymphoma (ZUMA-7)

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posted on 2024-01-08, 08:20 authored by Simone Filosto, Saran Vardhanabhuti, Miguel A. Canales, Xavier Poiré, Lazaros J. Lekakis, Sven de Vos, Craig A. Portell, Zixing Wang, Christina To, Marco Schupp, Soumya Poddar, Tan Trinh, Carmen M. Warren, Ethan G. Aguilar, Justin Budka, Paul Cheng, Justin Chou, Adrian Bot, Rhine R. Shen, Jason R. Westin

Supplementary Fig. 1. Duration of response did not associate with CAR T-cell peak expansion.

Supplementary Fig. 2. CAR T-cell peak did not associate with ongoing response in secondline LBCL.

Supplementary Fig. 3. Early CAR T-cell expansion correlated with ongoing response.

Supplementary Fig. 4. Naive T cells associated with improved outcome.

Supplementary Fig. 5. Association between toxicity and central memory T-cell product phenotype.

Supplementary Fig. 6. Association of product T-cell phenotypes/subpopulations with CAR Tcell expansion.

Supplementary Fig. 7. Naive enriched CAR T-cell product was more efficacious in vitro against tumor cells.

Supplementary Fig. 8. Select serum inflammatory and immune-modulatory analytes correlated with reduced efficacy and elevated toxicity at baseline and on day 0.

Supplementary Fig. 9. Association of T-cell subsets with posttreatment inflammatory serum analytes.

Supplementary Fig. 10. Elevated inflammatory profile at baseline differentially correlated with product phenotype.

Supplementary Fig. 11. Naive T-cell phenotype associated with higher peak level of VEGF.

Supplementary Fig. 12. Coculture IFN-γ associated with toxicity and T-cell phenotype.

Supplementary Fig. 13. Coculture IFN-γ association with toxicity and overall best response (CR versus others) by patient.

Supplementary Fig. 14. Association of apheresis CD27+CD28+CD8+ naive T cells with response.

Supplementary Fig. 15. T naive phenotype in second-line versus third-line LBCL.

Supplementary Fig. 16. Gating strategy for CD27 and CD28 costimulatory markers.

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ARTICLE ABSTRACT

Treatment resistance and toxicities remain a risk following chimeric antigen receptor (CAR) T-cell therapy. Herein, we report pharmacokinetics, pharmacodynamics, and product and apheresis attributes associated with outcomes among patients with relapsed/refractory large B-cell lymphoma (LBCL) treated with axicabtagene ciloleucel (axi-cel) in ZUMA-7. Axi-cel peak expansion associated with clinical response and toxicity, but not response durability. In apheresis material and final product, a naive T-cell phenotype (CCR7+CD45RA+) expressing CD27 and CD28 associated with improved response durability, event-free survival, progression-free survival, and a lower number of prior therapies. This phenotype was not associated with high-grade cytokine release syndrome (CRS) or neurologic events. Higher baseline and postinfusion levels of serum inflammatory markers associated with differentiated/effector products, reduced efficacy, and increased CRS and neurologic events, thus suggesting targets for intervention. These data support better outcomes with earlier CAR T-cell intervention and may improve patient care by informing on predictive biomarkers and development of next-generation products. In ZUMA-7, the largest randomized CAR T-cell trial in LBCL, a naive T-cell product phenotype (CCR7+CD45RA+) expressing CD27 and CD28 associated with improved efficacy, decreased toxicity, and a lower number of prior therapies, supporting earlier intervention with CAR T-cell therapy. In addition, targets for improvement of therapeutic index are proposed.This article is featured in Selected Articles from This Issue, p. 4

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