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

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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.

Reference

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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