Improved efficacy with early tocilizumab in the prophylaxis and treatment of cytokine release syndrome of chimeric antigen receptor T cell (CAR-T) therapy for diffuse large B-cell lymphoma than acute lymphoblastic leukemia
Background: Tocilizumab is a well-practiced strategy to manage cytokine release syndrome (CRS) after chimeric antigen receptor T cell (CAR-T) therapy. However, varied efficiency in CRS mitigation by tocilizumab has been reported to highlight affecting variables such as tumor types and timing of the...
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KeAi Communications Co., Ltd.
2023-09-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2949723X23000028 |
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| author | Chengxin Luan Haixia Wang Junjie Zhou Zhangbiao Long Xin Chen Xiaowen Chen Jing Ni Zhengqi Huang Ruixiang Xia Jian Ge |
| author_facet | Chengxin Luan Haixia Wang Junjie Zhou Zhangbiao Long Xin Chen Xiaowen Chen Jing Ni Zhengqi Huang Ruixiang Xia Jian Ge |
| author_sort | Chengxin Luan |
| collection | DOAJ |
| description | Background: Tocilizumab is a well-practiced strategy to manage cytokine release syndrome (CRS) after chimeric antigen receptor T cell (CAR-T) therapy. However, varied efficiency in CRS mitigation by tocilizumab has been reported to highlight affecting variables such as tumor types and timing of the administration. Objective: The objective of this study is to identify different curative effect between diffuse large B-cell lymphoma (DLBCL) and acute lymphoblastic leukemia (ALL) by early use of tocilizumab for prophylaxis and treatment of CRS. Methods: By retrospectively summarizing our institution's experience with a CAR-T clinical trial targeting CD19, 11 cases were analyzed: 5 DLBCL, and 6 ALL. The two groups were compared with patient characteristics, CRS information and clinical outcomes. 3 patients were pretreated with tocilizumab for prophylaxis and the rest were treated with tocilizumab at CRS diagnosis. Results: CRS occurred in 81.8% of patients (9/11), grade 3 or higher occurred in 55.6% of the CRS patients (5/9). The two group were similar in patient characteristics, CAR-T and CRS profile. However, tocilizumab produced much better efficacy against CRS in DLBCL group compared with ALL group (80% versus 16.7%, P = 0.08). Conclusions: Despite the statistical was non-significant, possibly due to small case pool and bias was unavoidable, our analysis suggested that early use of tocilizumab was more effective for DLBCL than ALL in the prophylaxis and treatment of CRS. A treatment algorithm for management of CRS with regard to DLBCL and ALL is proposed, which may extend to other local or systemic malignancies and warrant further investigation. |
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| language | English |
| last_indexed | 2024-03-12T13:19:14Z |
| publishDate | 2023-09-01 |
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| series | Biomedical Technology |
| spelling | doaj.art-318c40d0a0ac4162bd72a6440006f5142023-08-26T04:44:31ZengKeAi Communications Co., Ltd.Biomedical Technology2949-723X2023-09-0135965Improved efficacy with early tocilizumab in the prophylaxis and treatment of cytokine release syndrome of chimeric antigen receptor T cell (CAR-T) therapy for diffuse large B-cell lymphoma than acute lymphoblastic leukemiaChengxin Luan0Haixia Wang1Junjie Zhou2Zhangbiao Long3Xin Chen4Xiaowen Chen5Jing Ni6Zhengqi Huang7Ruixiang Xia8Jian Ge9Department of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, ChinaDepartment of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, ChinaDepartment of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, ChinaDepartment of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, ChinaDepartment of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, ChinaDepartment of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, ChinaDepartment of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, ChinaDepartment of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, ChinaDepartment of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, ChinaCorresponding author. Anhui Medical University, No.218, Jixi Road, Shushan District, Hefei, 230022, China.; Department of Hematology, The First Affiliated Hospital of Anhui Medical University, Hefei, ChinaBackground: Tocilizumab is a well-practiced strategy to manage cytokine release syndrome (CRS) after chimeric antigen receptor T cell (CAR-T) therapy. However, varied efficiency in CRS mitigation by tocilizumab has been reported to highlight affecting variables such as tumor types and timing of the administration. Objective: The objective of this study is to identify different curative effect between diffuse large B-cell lymphoma (DLBCL) and acute lymphoblastic leukemia (ALL) by early use of tocilizumab for prophylaxis and treatment of CRS. Methods: By retrospectively summarizing our institution's experience with a CAR-T clinical trial targeting CD19, 11 cases were analyzed: 5 DLBCL, and 6 ALL. The two groups were compared with patient characteristics, CRS information and clinical outcomes. 3 patients were pretreated with tocilizumab for prophylaxis and the rest were treated with tocilizumab at CRS diagnosis. Results: CRS occurred in 81.8% of patients (9/11), grade 3 or higher occurred in 55.6% of the CRS patients (5/9). The two group were similar in patient characteristics, CAR-T and CRS profile. However, tocilizumab produced much better efficacy against CRS in DLBCL group compared with ALL group (80% versus 16.7%, P = 0.08). Conclusions: Despite the statistical was non-significant, possibly due to small case pool and bias was unavoidable, our analysis suggested that early use of tocilizumab was more effective for DLBCL than ALL in the prophylaxis and treatment of CRS. A treatment algorithm for management of CRS with regard to DLBCL and ALL is proposed, which may extend to other local or systemic malignancies and warrant further investigation.http://www.sciencedirect.com/science/article/pii/S2949723X23000028Chimeric antigen receptor T cell therapyCytokine release syndromeTocilizumabDiffuse large B-cell lymphoma (DLBCL)Acute lymphoblastic leukemia (ALL) |
| spellingShingle | Chengxin Luan Haixia Wang Junjie Zhou Zhangbiao Long Xin Chen Xiaowen Chen Jing Ni Zhengqi Huang Ruixiang Xia Jian Ge Improved efficacy with early tocilizumab in the prophylaxis and treatment of cytokine release syndrome of chimeric antigen receptor T cell (CAR-T) therapy for diffuse large B-cell lymphoma than acute lymphoblastic leukemia Biomedical Technology Chimeric antigen receptor T cell therapy Cytokine release syndrome Tocilizumab Diffuse large B-cell lymphoma (DLBCL) Acute lymphoblastic leukemia (ALL) |
| title | Improved efficacy with early tocilizumab in the prophylaxis and treatment of cytokine release syndrome of chimeric antigen receptor T cell (CAR-T) therapy for diffuse large B-cell lymphoma than acute lymphoblastic leukemia |
| title_full | Improved efficacy with early tocilizumab in the prophylaxis and treatment of cytokine release syndrome of chimeric antigen receptor T cell (CAR-T) therapy for diffuse large B-cell lymphoma than acute lymphoblastic leukemia |
| title_fullStr | Improved efficacy with early tocilizumab in the prophylaxis and treatment of cytokine release syndrome of chimeric antigen receptor T cell (CAR-T) therapy for diffuse large B-cell lymphoma than acute lymphoblastic leukemia |
| title_full_unstemmed | Improved efficacy with early tocilizumab in the prophylaxis and treatment of cytokine release syndrome of chimeric antigen receptor T cell (CAR-T) therapy for diffuse large B-cell lymphoma than acute lymphoblastic leukemia |
| title_short | Improved efficacy with early tocilizumab in the prophylaxis and treatment of cytokine release syndrome of chimeric antigen receptor T cell (CAR-T) therapy for diffuse large B-cell lymphoma than acute lymphoblastic leukemia |
| title_sort | improved efficacy with early tocilizumab in the prophylaxis and treatment of cytokine release syndrome of chimeric antigen receptor t cell car t therapy for diffuse large b cell lymphoma than acute lymphoblastic leukemia |
| topic | Chimeric antigen receptor T cell therapy Cytokine release syndrome Tocilizumab Diffuse large B-cell lymphoma (DLBCL) Acute lymphoblastic leukemia (ALL) |
| url | http://www.sciencedirect.com/science/article/pii/S2949723X23000028 |
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