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eMAP – electronic EHA Medical HemAtology Program

CAR T cells Associated Acute Toxicity in B-cell Non-Hodgkin Lymphoma: Real-World
Study From the DESCAR-T Registry

Sesques P, et al. Presented at EHA 2022 Congress. Abstract S210.

Common immune-related toxicities associated with chimeric antigen receptor (CAR) T cell therapies include cytokine release
syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), which can be severe and potentially
life threatening. The objective of this French group was to assess predictive factors for severe CRS and ICANS in a real world
population (large cohort of R/R aggressive B-cell lymphoma patients treated with either axi-cel or tisa-cel from the DESCAR-T
registry).

A total of 705 patients were included in the toxicity analysis
with a median follow up of 12 months. CRS occurred in
83.3% of patients (8.6% with grade =3 events) and ICANS
occurred in 41% of patients (11% with grade =3 events).
It is notable that most patients with ICANS had previously
experienced CRS (only 2.2% of ICANS without CRS).
About 25% of patients required admission to the intensive
care unit (ICU), with a mean duration of stay of two days. In
terms of management, tocilizumab was the most common
treatment for toxicity, seen in 58.3% of patients, followed by
corticosteroid use seen in 38.5% of patients. Neither grade
=3 CRS or ICANS, nor use of tocilizumab or corticosteroids
for toxicity management, had negative impacts on survival.

In a multivariate analysis, predictive factors for CRS were
bulky mass >5 cm, age <65 years, C-reactive protein
(CRP) =30 mg/L (lymphodepletion), and de novo diffuse
large B-cell lymphoma (DLBCL, see Figure). Predictive
factors for ICANS were female sex, CRP =30 mg/L
(lymphodepletion), and bridging status (no bridge or non-
responder) (see Figure).

The study authors concluded that predictive factors of CRS
and ICANS were identified in a large multicentric cohort,
and risk scores are easy to compute based on routine
predictive data for patients treated with CAR T cells. Further
analyses and validation will be required.

CR, complete response; CRP, C-reactive protein; CRS, cytokine release syndrome; DHL/THL, double-hit 5
lymphoma/triple-hit lymphoma; DLBCL, diffuse large B-cell lymphoma; ICANS, immune effector cell-
associated neurotoxicity syndrome; NOS, not otherwise specified; OR, odds ratio; PD, progressive disease;
PMBCL, primary mediastinal large B-cell lymphoma; PR, partial response; SD, stable disease.

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