Chimeric antigen receptor T-cell therapy yields similar outcomes in patients with and without cytokine release syndrome

Chimeric antigen receptor (CAR) T-cell therapy revolutionized treatment for many patients with aggressive relapsed or refractory large B-cell lymphoma (LBCL) Treatment can be complicated by clinically evident cytokine release syndrome (CRS), which is characterized by the development of fevers, hypoxia, and hypotension and can be life-threatening. Most patients treated with CAR T cells develop CRS, which is thought to represent an immune phenomenon. It was previously unknown if patients who do not develop CRS have reduced CAR T-cell activity and therefore are likely to have worse outcomes. We conducted a multicenter retrospective analysis that included 352 adult patients treated at eight academic medical centers within the United States who received axicabtagene ciloleucel or tisagenlecleucel for treatment of LBCL. Outcomes of interest included progression free survival, overall survival, complete response rate, and overall response rate. Of the included patients, 262 (74.4%) developed CRS. There was no significant difference in progression free (p=0.99) or overall survival (p=0.16) between patients who developed CRS and those who did not. Peak ferritin during treatment >5000 and lactate dehydrogenase greater than the institutional upper limit of normal prior to lymphodepleting chemotherapy were associated in multivariate analysis with significantly worse progression free and overall survival. There was no significant difference in complete response or overall response rate between patients who did and did not develop CRS. In this retrospective analysis, we report that patients who develop CRS have similar clinical outcomes compared to patients without CRS treated with commercial anti-CD19 CAR T cells.