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@ARTICLE{Biederstdt:303085,
author = {A. Biederstädt and F. Bassermann$^*$ and J. S. Hecker},
title = {{A}llogeneic {CAR}-engineered cellular therapy for relapsed
and refractory large {B} cell lymphoma: a systematic review
and meta-analysis.},
journal = {Frontiers in immunology},
volume = {16},
issn = {1664-3224},
address = {Lausanne},
publisher = {Frontiers Media},
reportid = {DKFZ-2025-01510},
pages = {1585556},
year = {2025},
abstract = {Relapsed/refractory (r/r) large B-cell lymphoma (LBCL)
remains a difficult-to-treat disease with limited treatment
options and high unmet clinical need, necessitating the
development of new therapies with greater potency and
broader applicability. While autologous chimeric antigen
receptor (CAR)-T cell therapies have transformed the
treatment landscape, $60-65\%$ of patients receiving these
therapies eventually relapse, underscoring the need for
improved approaches. Allogeneic CAR-T and CAR-NK cell
therapies have recently emerged as promising alternatives,
offering the potential to shorten manufacturing times,
reduce costs, and expand access to a broader patient
population. This systematic review and meta-analysis
compiles the currently available clinical trial data on the
efficacy and safety of these novel therapies in adult
patients with r/r LBCL.A systematic search of MEDLINE,
EMBASE, Web of Science, and the Cochrane Central Register of
Controlled Trials was conducted for studies published up to
January 12, 2025, involving allogeneic CAR-T and CAR-NK cell
therapies in R/R LBCL. The primary outcomes assessed were
the best overall response rate (bORR) and best complete
response rate (bCRR) at any time point. Secondary outcomes
included rates of grade 1-2 and grade 3+ cytokine release
syndrome (CRS), grade 1-2 and grade 3+ immune effector
cell-associated neurotoxicity syndrome (ICANS), grade 1-2
and grade 3+ infections and incidence of graft-versus-host
disease (GvHD).Nineteen studies met the inclusion and
exclusion criteria, encompassing 334 patients (155 CAR-NK;
179 CAR-T) evaluable for safety and 235 patients evaluable
for response (77 CAR-NK; 158 CAR-T). The pooled estimates
for the best overall response rate (bORR) and the best
complete response rate (bCRR) were $52.5\%$ $[95\%$ CI,
41.0-63.9] and $32.8\%$ $[95\%$ CI, 24.2-42.0],
respectively. Safety analysis revealed very low incidences
of grade 3+ CRS $(0.04\%$ $[95\%$ CI 0.00-0.49]) or grade 3+
ICANS $(0.64\%$ $[95\%$ CI 0.01-2.23]) and only one
occurrence of a GvH-like reaction across 334 infused
patients enrolled in the included studies, highlighting the
remarkable safety profile of CAR-engineered 'off-the-shelf'
allogeneic approaches. The estimated overall incidence of
low-grade CRS was $30\%$ $[95\%$ CI, 14-48], while the
estimated overall incidence of low-grade ICANS was $1\%$
$[95\%$ CI, $0\%-4\%],$ markedly lower than
current-generation autologous CAR-T cell products. The
incidence of low-grade and severe infections was $25\%$
$[95\%$ CI $14-36\%)$ (n=252) and $7\%$ $[95\%$ CI $2-14\%]$
(n=291), respectively.Together, allogeneic CAR-T and CAR-NK
cell therapies demonstrate encouraging efficacy in heavily
pretreated patients with r/r LBCL. Coupled with their
favorable safety profiles and the potential for
off-the-shelf availability, allogeneic cell therapies hold
great promise to broaden the reach of live cell-based
treatments, delivering impactful results to a wider patient
population in the coming years.},
subtyp = {Review Article},
keywords = {Humans / Immunotherapy, Adoptive: methods / Immunotherapy,
Adoptive: adverse effects / Receptors, Chimeric Antigen:
immunology / Receptors, Chimeric Antigen: genetics /
Lymphoma, Large B-Cell, Diffuse: therapy / Lymphoma, Large
B-Cell, Diffuse: immunology / Treatment Outcome / Neoplasm
Recurrence, Local: therapy / Killer Cells, Natural:
immunology / Killer Cells, Natural: transplantation /
Transplantation, Homologous / CRISPR gene editing (Other) /
adoptive cell therapy (ACT) (Other) / allogeneic CAR-NK
cells (Other) / allogeneic CAR-T cells (Other) / cellular
engineering (Other) / clinical trial (Other) / large B cell
lymphoma (Other) / precision gene editing (Other) /
Receptors, Chimeric Antigen (NLM Chemicals)},
cin = {MU01},
ddc = {610},
cid = {I:(DE-He78)MU01-20160331},
pnm = {899 - ohne Topic (POF4-899)},
pid = {G:(DE-HGF)POF4-899},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:40698082},
pmc = {pmc:PMC12279871},
doi = {10.3389/fimmu.2025.1585556},
url = {https://inrepo02.dkfz.de/record/303085},
}