Pierre Sesques, Amy A Kirkwood, Mi Kwon, Kai Rejeski, Michael D Jain, Roberta Di Blasi, Gabriel Brisou, François-Xavier Gros, Fabien le Bras, Pierre Bories, Sylvain Choquet, Marie-Thérèse Rubio, Gloria Iacoboni, Maeve O'Reilly, René-Olivier Casasnovas, Jacques-Olivier Bay, Mohamad Mohty, Magalie Joris, Julie Abraham, Cristina Castilla Llorente, Mickael Loschi, Sylvain Carras, Adrien Chauchet, Laurianne Drieu La Rochelle, Olivier Hermine, Stéphanie Guidez, Pascale Cony-Makhoul, Patrick Fogarty, Steven Le Gouill, Franck Morschhauser, Thomas Gastinne, Guillaume Cartron, Marion Subklewe, Frederick L Locke, Robin Sanderson, Pere Barba, Roch Houot, Emmanuel Bachy
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引用次数: 0
Abstract
Autologous anti-CD19 chimeric antigen receptor (CAR) T cells are now used in routine practice for relapsed/refractory (R/R) large B-cell lymphoma (LBCL). Severe (grade ≥ 3) cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity (ICANS) are still the most concerning acute toxicities leading to frequent intensive care unit (ICU) admission, prolonging hospitalization, and adding significant cost to treatment. We report on the incidence of CRS and ICANS and the outcomes in a large cohort of 925 patients with LBCL treated with axicabtagene ciloleucel (axi-cel) or tisagenlecleucel (tisa-cel) in France based on patient data captured through the DESCAR-T registry. CRS of any grade occurred in 778 patients (84.1%), with 74 patients (8.0%) with grade 3 CRS or higher, while ICANS of any grade occurred in 375 patients (40.5%), with 112 patients (12.1%) with grade ≥ 3 ICANS. Based on the parameters selected by multivariable analyses, two independent prognostic scoring systems (PSS) were derived, one for grade ≥ 3 CRS and one for grade ≥ 3 ICANS. CRS-PSS included bulky disease, a platelet count < 150 G/L, a C-reactive protein (CRP) level > 30 mg/L and no bridging therapy or stable or progressive disease (SD/PD) after bridging. Patients with a CRS-PSS score > 2 had significantly higher risk to develop grade ≥ 3 CRS. ICANS-PSS included female sex, low level of platelets (< 150 G/L), use of axi-cel and no bridging therapy or SD/PD after bridging. Patients with a CRS-PSS score > 2 had significantly higher risk to develop grade ≥ 3 ICANS. Both scores were externally validated in international cohorts of patients treated with tisa-cel or axi-cel.
期刊介绍:
The Journal of Hematology & Oncology, an open-access journal, publishes high-quality research covering all aspects of hematology and oncology, including reviews and research highlights on "hot topics" by leading experts.
Given the close relationship and rapid evolution of hematology and oncology, the journal aims to meet the demand for a dedicated platform for publishing discoveries from both fields. It serves as an international platform for sharing laboratory and clinical findings among laboratory scientists, physician scientists, hematologists, and oncologists in an open-access format. With a rapid turnaround time from submission to publication, the journal facilitates real-time sharing of knowledge and new successes.