Predictive factors and nomogram for the risk of cytokine release syndrome with anti-CD3 × CD20 bispecific antibodies for Chinese patients.

Background: Targeting CD3 × CD20 bispecific antibodies (BsAbs) represents a new milestone in the salvage therapy of relapsed/relapsed large B cell lymphoma and follicular lymphoma. However, cytokine release syndrome (CRS) remains one of the major concerns in clinical practice of CD3 × CD20 BsAbs. This study aimed to identify the potential predictive factors and to construct a nomogram of grade ≥ 2 CRS in CD3 × CD20 BsAbs in Chinese patients.

Methods: A total of 87 consecutive patients with B-NHL who received CD3 × CD20 BsAbs at Sun Yat-sen University Cancer Center from January 2021 to December 2023 were included and analyzed. Clinical data were collected, and various methods including machine learning algorithms were introduced.

Results: The median age of the patients was 55 years, and the median number of previous treatment lines was 2. CRS occurred in 42 patients (48.3%), including 27 cases of grade 1, 9 cases of grade 2, 5 cases of grade 3, and 1 case of grade 5. Four variables were revealed and selected: bulky disease (> 5 cm), number of previous treatment lines (≥ 3), monocyte-to-lymphocyte ratio (MLR), and platelet count (PLT). Bootstrap resampling was introduced for both internal validation and model building. A predictive nomogram was ultimately established, with the ROC-AUC of 0.867 (95% CI 0.719-0.954).

Conclusion: This study suggests four potential predictive factors and provides a feasible and easy-to-use nomogram for grade ≥ 2 CRS in Chinese patients for the first time, which is important for guiding personalized management and early intervention of CRS.