Lenalidomide Exposure at Time of CAR T-Cells Expansion Enhances Response of Refractory/Relapsed Aggressive Large B-Cell Lymphomas

Background. Anti-CD19 Chimeric Antigen Receptor (CAR) T-cells represent a major therapeutic advance in the management of patients (pts) with relapsed/refractory aggressive large B-cell lymphoma (R/R aggressive LBCL) with reported overall response rates between 40% and 83% in the pivotal trials (ZUMA1, JULIET, TRANSCEND) as well as in the real-life cohorts with either axicabtagene ciloleucel (axi-cel, Yescarta) or tisagenlecleucel (tisa-cel, Kymriah). However, a significant number of pts will experience failure after infusion, 20% to 35% of these failures occurring early during the first month. Lenalidomide is reported to activate CD8 T-cells, to inhibit regulatory T-cells and to restore T-cell immune synapse. Here, we report our experience with early exposure to Lenalidomide (LEN) in the treatment of early failure (<15 days) after axi-cel or tisa-cel for R/R aggressive LBCL.