Rates of ICANS, Steroid Use Higher With Axicabtagene Ciloleucel Than With Tisagenlecleucel


A real-world study suggests that immune effector cell-associated neurotoxicity syndrome (ICANS) and corticosteroid use are more common after treatment with axicabtagene ciloleucel (axi-cel) than with tisagenlecleucel (tisa-cel) in patients with relapsed/refractory large B-cell lymphoma (LBCL).

Rates of grade 3-5 cytokine release syndrome (CRS) were similar with both chimeric antigen receptor (CAR) T-cell therapies.

These results were presented at the 2021 American Society of Hematology (ASH) Annual Meeting by Robin Sanderson, PhD, of King’s College Hospital in London, United Kingdom.

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Dr Sanderson and colleagues collected data from 341 consecutively infused patients with relapsed/refractory LBCL. They were treated at 10 CAR-T infusion centers from January 2019 to April 2021.

The cohort included 261 patients who received axi-cel and 80 patients who received tisa-cel.

Toxicity and Management

The rate of grade 3-5 CRS was 8.8% with axi-cel and 7.5% with tisa-cel. The rate of grade 3-5 ICANS was 21% and 5%, respectively.

Tocilizumab was given to 74% of patients in the axi-cel group and 48% in the tisa-cel group. The median time to tocilizumab initiation was 4 days (range, 0-18 days) and 3 days (range, 0-8 days), respectively.

Corticosteroids were given to 44% of patients treated with axi-cel. The median dose was 165 mg (range, 10-2182 mg), administered over a median of 8 days (range, 1-86 days).

In the tisa-cel cohort, 18% of patients received corticosteroids. The median dose was 95 mg (range, 10-220 mg), administered over a median of 4 days (range 1-8).

Anakinra was given to 12.6% of axi-cel patients, for both high-grade ICANS (79%) and high-grade CRS (30%). The median time to start was day 8, and the median duration of treatment was 6 days. The median corticosteroid dose in this group was 380 mg (range, 0-2182 mg).

Risk Factors and Survival

In a multivariate analysis, having an Eastern Cooperative Oncology Group performance status greater than 0 before lymphodepletion was associated with grade 3-5 CRS (odds ratio [OR], 3.3; 95% CI, 1.3-9.1; P =.02).

Lactate dehydrogenase greater than normal on day 0 was predictive of grade 3-5 ICANS (OR, 3.8; 95% CI, 1.4-10.5; P <.01).

Neither grade 3-5 CRS nor ICANS was significantly associated with progression-free survival (PFS). Similarly, there was no association between corticosteroid use and PFS.

Neither grade 3-5 CRS nor corticosteroid use was significantly associated with overall survival (OS). However, grade 3-5 ICANS was associated with worse OS (hazard ratio, 2.5; 95% CI, 1.3-4.4; P =.004).

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Read more of Cancer Therapy Advisor’s coverage of the ASH 2021 meeting by visiting the conference page.


Sanderson R, Kuhnl A, Tholouli E, et al. CAR-T toxicity management and steroid use in high-grade B-cell lymphoma: Impact on real-world survival outcomes in the UK. Presented at ASH 2021; December 11-14, 2021. Abstract 531.

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