Mokhtari Sepideh, Asquith Justin M, Kareem Syeda Saba, Bachmeier Christina A, Pina Yolanda, Faramand Rawan G, Kim Youngchul, Peguero Edwin N, Sahebjam Solmaz, Jaffer Mohammad H, Iacono David P, Jain Michael D, Vogelbaum Michael A, Davila Marco L, Forsyth Peter A, Locke Frederick L, Lazaryan Aleksandr
Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.
Department of Medical Oncology, Aspirus Cancer Care, Wausau, WI 54401, USA.
Int J Mol Sci. 2025 Apr 21;26(8):3904. doi: 10.3390/ijms26083904.
Severe immune effector cell-associated neurotoxicity syndrome (ICANS) occurs in about 30% of all patients with large B-cell lymphoma (LBCL) who are treated with axicabtagene ciloleucel (axi-cel). There are currently limited treatment strategies other than the standard corticosteroids, and it is essential to find additional therapies to manage severe ICANS. We conducted a retrospective study of neurologic outcomes among patients who received axi-cel for LBCL from May 2015 to February 2019. We identified patients who developed severe ICANS and were treated with glucocorticoids followed by intravenous immunoglobulin (IVIG) (n = 9) or glucocorticoids alone (n = 10). There was no statistically significant difference in the time to resolution (TTR) of severe ICANS between groups; however, patients in the IVIG had more severe grades of ICANS with a lower performance status at baseline. The cumulative steroid days were 11.2 in the IVIG arm and 13.5 in the glucocorticoids-only arm. The use of IVIG for severe ICANS after axi-cel therapy was tolerable and safe and is generally recommended in the CAR-T setting in patients with hypogammaglobinemia. The use of IVIG as a potential therapeutic agent for severe ICANS can be further explored in future prospective studies.
严重免疫效应细胞相关神经毒性综合征(ICANS)发生在约30%接受axi-cel(阿基仑赛注射液)治疗的大B细胞淋巴瘤(LBCL)患者中。除了标准的皮质类固醇外,目前治疗策略有限,因此找到额外的疗法来治疗严重的ICANS至关重要。我们对2015年5月至2019年2月期间接受axi-cel治疗LBCL的患者的神经学结局进行了一项回顾性研究。我们确定了发生严重ICANS并接受糖皮质激素治疗随后接受静脉注射免疫球蛋白(IVIG)的患者(n = 9)或仅接受糖皮质激素治疗的患者(n = 10)。两组之间严重ICANS的缓解时间(TTR)没有统计学上的显著差异;然而,接受IVIG治疗的患者ICANS分级更严重,基线时体能状态更低。IVIG组的累积类固醇使用天数为11.2天,仅使用糖皮质激素组为13.5天。axi-cel治疗后使用IVIG治疗严重ICANS是可耐受且安全的,在低丙种球蛋白血症的CAR-T治疗环境中通常推荐使用。IVIG作为严重ICANS的潜在治疗药物的应用可在未来的前瞻性研究中进一步探索。
Am Soc Clin Oncol Educ Book. 2019-1
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