A study exploring toxicity from axicabtagene ciloleucel in the real-world setting demonstrates the necessity for more studies exploring real-world experience and data to define and refine management of toxicities unique to CAR-T therapy (Clin Lymphoma Myeloma Leuk. 2020;S2152-2650[20]30557-7. doi:10.1016/j.clml.2020.10.005).
“Recent advances in immunotherapy have resulted in the development of [CAR-T] therapy, such as axicabtagene ciloleucel (axi-cel). However, axi-cel administration is not without risks of toxicity,” wrote Allison Grana, PharmD, BCOP, The University of Texas MD Anderson Cancer Center, Houston, and colleagues.
This retrospective study evaluated the incidence and severity of common and severe adverse events after treatment with axi-cel.
A total of 37 patients with relapsed or refractory DLBCL were included in the study. Of these patients, 90% had received ≥3 prior lines of therapy (median prior therapies 3, range 2-7) before receiving CAR-T infusion, and 32.4% had relapsed after prior stem cell transplantation.
Overall, 36 (97.3%) patients experienced cytokine release syndrome (CRS) of any grade. Of these patients, 83.3% had a maximum of grade 1 or 2 CRS, occurring after a median of 27 hours and persisting for a median of 6 days.
Additionally, 27 (73%) patients experienced neurotoxicity of any grade. Of these patients, 96.3% had a maximum of grade ≥2 neurotoxicity, occurring after a median of 145 hours (6 days) and persisting for a median of 7 days.
Dr Grana and colleagues noted that all patients aged 65 or older (n = 10) experienced grade ≥2 neurotoxicity after CAR-T infusion compared with 59.3% (11 of 27 patients) under age 65.
“With more real-life experience and data, we will be able to define and refine management of toxicities unique to CAR-T therapy,” Dr Grana and colleagues concluded.—Janelle Bradley
