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G-CSF does not worsen toxicities and efficacy of CAR-T cells in refractory/relapsed B-cell lymphoma

Bone Marrow Transplantation volume 55, pages 2347–2349 (2020)Cite this article

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Chimeric antigen receptor T cells (CAR-T) are an outbreaking treatment option for relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL). Currently commercial available CAR-T are Tisagenlecleucel (Tisa-cel), indicated in R/R DLBCL and acute lymphoblastic leukemia [1], and Axicabtagene-ciloleucel (Axi-cel), authorized for R/R DLBCL, primary mediastinal B-cell lymphoma, and transformed follicular lymphoma [2]. Attended overall response rate (ORR) and complete response rate (CRR) of CAR-T therapy are 63% and 39%, respectively [3].

Safety profile of CAR-T involves well-established toxicities, as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). CRS is a systemic inflammatory response provoked by soluble mediators with wide clinical spectrum, ranging from mild flu-like syndrome to severe shock. ICANS is the other described complication, possibly involving an endothelial toxicity and causing variable neurologic signs, from slightly impaired cognitive function to coma or fatal seizures [4]. Both CRS and ICANS have been recently object of a consensus for harmonize different gradings previously in use [5]. Other toxicities such as hematologic toxicities, despite often observed, are less reported: in 2019 Fried et al. described 72% severe neutropenia and 28% severe thrombocytopenia in 29 responding patients affected by R/R B-cell malignancies treated by CAR-T [6].

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For data, please contact Catherine Thieblemont (catherine.thieblemont@aphp.fr).

References

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Authors and Affiliations

  1. APHP, Hôpital Saint-Louis, Service Hématologie Oncologie, Université de Paris, Paris, France

    Eugenio Galli, Roberta Di Blasi, Sophie Bernard, Hannah Moatti & Catherine Thieblemont

  2. Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy

    Eugenio Galli & Roberta Di Blasi

  3. APHP, Hôpital Saint-Louis, Laboratoire d’Immunologie, Université de Paris, Paris, France

    Vincent Allain, Florence Morin & Sophie Caillat-Zucman

  4. APHP, Hôpital Saint-Louis, Service de Médecine Nucléaire, Paris, France

    Laetitia Vercellino

  5. APHP, Hôpital Saint-Louis, Service Biostatistiques, Université de Paris, Paris, France

    Sylvie Chevret

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  1. Eugenio Galli
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Contributions

EG, CT, and RDB systematically collected and organized data. SC and EG performed statistical analysis. SB, HM, RDB, EG, and CT provided clinical data and assured optimal management during the procedure. VA, FM, and SC-Z performed laboratory analysis on CAR-T expansion and elaborated concerning data. LV supervised and standardized all PET-CT results. EG and CT drafted the paper. All authors critically reviewed the paper.

Corresponding author

Correspondence to Eugenio Galli.

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Conflict of interest

RDB received honoraria from Kyte and Novartis. CT received consulting honoraria from Amgen, Celgene, Jazz Pharma, Kyte, Novartis, Servier, Roche, and research fundings from Roche and Celgene. All others authors declare no conflict of interest.

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Galli, E., Allain, V., Di Blasi, R. et al. G-CSF does not worsen toxicities and efficacy of CAR-T cells in refractory/relapsed B-cell lymphoma. Bone Marrow Transplant 55, 2347–2349 (2020). https://doi.org/10.1038/s41409-020-01006-x

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