Search

This article discusses two cases of patients with large B-cell lymphoma (LBCL) who experienced adverse reactions during treatment with axicabtagene-ciloleucel. In the first case, the patient developed cytokine release syndrome (CRS) within 72 hours of starting the therapy. In the second case, the patient developed immune effector cell-associated neurotoxicity syndrome (ICANS) despite receiving dexamethasone prophylaxis. These cases highlight potential side effects and lack of efficacy of these treatments for LBCL. [Extracted from the article]

A 74-year-old woman with central nervous system-relapsed mantle cell lymphoma experienced grade 1 cytokine release syndrome and grade 2 immune effector cell-associated neurotoxicity syndrome during treatment with brexucabtagene-autoleucel. She also showed a lack of efficacy with various other treatments, including rituximab, ibrutinib, methotrexate, cytarabine, dexamethasone, and tocilizumab. Despite these challenges, the woman achieved complete remission of mantle cell lymphoma after treatment with brexucabtagene-autoleucel. [Extracted from the article]

A 77-year-old man with multiple myeloma developed immune effector cell associated neurotoxicity syndrome (ICANS), cytokine release syndrome (CRS), and parkinsonism during treatment with idecabtagene-vicleucel. He initially experienced grade 1 CRS, which was treated with tocilizumab. On day 23, he developed ICANS, characterized by tremor and gait impairment. Neurological examination revealed parkinsonism symptoms. Treatment with dexamethasone led to improvement in symptoms, and by day 90, all neurological symptoms had resolved. [Extracted from the article]

A man in his 40s with Philadelphia chromosome positive (Ph+) acute lymphoblastic leukemia (ALL) experienced lack of efficacy with dasatinib treatment. He then received brexucabtagene-autoleucel and developed cytokine release syndrome and immune effector cell associated neurotoxicity syndrome, which resolved. The patient later showed improvement in ALL and underwent a second allogeneic hematopoietic stem-cell transplantation. [Extracted from the article]

A retrospective study examined 39 adults with multiple myeloma who were treated with teclistamab between October 2022 and June 2023. Three patients developed cytokine release syndrome (CRS) or immune effector cell-associated neurotoxicity syndrome (ICANS) as a result of the treatment. The patients experienced varying grades of CRS and ICANS and were admitted to the hospital. However, all patients were able to complete the teclistamab treatment. [Extracted from the article]

A 50-year-old man with mantle cell lymphoma (MCL) and central nervous system (CNS) involvement experienced lack of efficacy with ibrutinib and lenalidomide. He later developed cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) while being treated with brexucabtagene-autoleucel for MCL with CNS involvement. Despite previous treatments and a relapse, the patient achieved a complete response after receiving fludarabine and cyclosphosphamide lymphodepletion followed by brexucabtagene-autoleucel infusion. The patient's MCL with CNS involvement improved and he achieved a complete response. [Extracted from the article]

Two case reports describe patients with relapsed/refractory multiple myeloma who developed cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) after receiving outpatient teclistamab step-up dosing. The first patient experienced grade 1 CRS and grade 1 ICANS, while the second patient had grade 2 CRS. Both patients were admitted for observation and management, and were treated with tocilizumab and dexamethasone. After treatment, both patients experienced prompt resolution of CRS/ICANS and were able to complete the step-up dosing without recurrence of the toxicities. [Extracted from the article]

A 74-year-old man with diffuse large B-cell lymphoma developed cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS) during treatment with axicabtagene ciloleucel. Despite receiving tocilizumab, dexamethasone, anakinra, and methylprednisolone for ICANS, the patient did not show any improvement (lack of efficacy). His condition worsened, and he eventually died after three months of symptom onset. Autopsy was not performed. [Extracted from the article]

A 26-year-old man with refractory diffuse large B-cell lymphoma developed cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) during treatment with axicabtagene ciloleucel. He experienced fever and tachycardia consistent with grade 1 CRS, followed by rapidly progressive ICANS characterized by handwriting impairment and encephalopathy. The patient received tocilizumab and dexamethasone, and his ICANS ultimately resolved. MRI scans showed initial abnormalities that later resolved. [Extracted from the article]

However, after 1-11 days, 15 patients developed CART cell therapy related-CRS (grade 1 in 12 patients, grade 2 in 2 patients, grade 3 in 1 patient). Two patients developed immune effector cell-associated neurotoxicity syndrome (ICANS) during treatment with tisagenlecleucel or brexucabtagene autoleucel for DLBCL or MCL [ I dosages and outcomes not stated i ] All the patients were diagnosed with DLBCL (14 patients) and MCL (2 patients). Later, the patients started receiving treatment with infusions of tisagenlecleucel (11 patients), axicabtagene ciloleucel (3 patients) and brexucabtagene autoleucel (2 patients). [Extracted from the article]

Thereafter, he also received weekly triple intrathecal therapy with methotrexate, cytarabine and hydrocortisone sodium succinate. However, refractory B-lymphoblastic lymphoma and persistent blasts in the CSF despite were noted during the treatment, indicating lack of efficacy with methotrexate, cytarabine and hydrocortisone sodium succinate. In this abstract, the authors reported lack of efficacy with methotrexate, cytarabine and hydrocortisone sodium succinate.". [Extracted from the article]

The remaining patient developed cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome during treatment with tisagenlecleucel for B-ALL [ I routes, dosages and durations of treatment to reactions onsets and outcomes not stated i ]. Subsequently, he developed grade II cytokine release syndrome (CRS) and grade III immune effector cell-associated neurotoxicity syndrome (ICANS). [Extracted from the article]

He received six courses of an R-CHOP regimen comprising rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone, and two additional doses of rituximab. B Author Information b An event is serious (based on the ICH definition) when the patient outcome is: * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important event A 56-year-old man exhibited lack of efficacy during treatment with rituximab, gemcitabine, oxaliplatin, cyclophosphamide and prednisone for post-transplant lymphoproliferative disorder (PTLD). He was prescribed bridging therapy with 2 cycles of cyclophosphamide 500 mg/m SP 2 sp day 1 and prednisone 60 mg/m SP 2 sp day 1-5. [Extracted from the article]

It was noted that his neurotoxicity symptoms occurred before dexamethasone was added for cytokine release syndrome treatment. B Author Information b An event is serious (based on the ICH definition) when the patient outcome is: * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important event In a study, two men aged 53-70 years were described, who developed immune effector cell-associated neurotoxicity (ICANS) and cytokine release syndrome (CRS) during treatment with axicabtagene ciloleucel [ I dosages not stated; not all outcomes and durations of treatments to reactions onsets not stated i ]. [Extracted from the article]

B Author Information b An event is serious (based on the ICH definition) when the patient outcome is: * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important event In the case report, 2 patients [66-year-old man and 69-year-old woman] were described, who developed cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity (ICANS) during treatment with axicabtagene ciloleucel for diffuse large B cell lymphoma (DLBCL) [ I dosages not stated i ]. He was treated with IV methylprednisolone sodium succinate [Solumedrol], his treatment with tocilizumab was resumed. [Extracted from the article]

Prior to the chemotherapy, she received chimeric antigen receptor (CAR) T-cell therapy with axicabtagene-ciloleucel [Axi-cel] 2×10 SP 6 sp anti-CD19 CAR T-cells/kg). Axicabtagene-ciloleucel/tocilizumab: Cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome: case report B Author Information b An event is serious (based on the ICH definition) when the patient outcome is: * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important event A 35-year-old woman developed cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) following treatment with axicabtagene-ciloleucel and tocilizumab for large B-cell lymphoma [ I not all routes and dosages stated i ]. [Extracted from the article]

She received IV methotrexate 1000 mg/m SP 2 sp on day 1, IV high-dose cytarabine 3000 mg/m SP 2 sp every 12h days 2+3, and IT cytarabine 100mg on day 7 (course B). She received one cycle of FLAG regimen comprising IV fludarabine 30 mg/m SP 2 sp /day, high-dose IV cytarabine 2000 mg/m SP 2 sp /day, days 1-5, and filgrastim, plus IV vincristine 2mg on day 8. [Extracted from the article]

The patients, who had LBCL (six patients) and CLL (one patient) at stage II-IV, underwent allogeneic haematopoietic cell transplantation (alloHCT) following pre-conditioning with various chemotherapeutic agents. Out of the seven patients, five patients developed grade 1-3 CRS and one patient developed grade 4 ICANS. B Author Information b An event is serious (based on the ICH definition) when the patient outcome is: * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important event In a case series, 7 patients [ I sexes not stated i ] aged 28-70years were described, who developed graft versus host disease (GVHD) with skin, ocular, oral or liver involvement, cytokine release syndrome (CRS) or immune effector cell-associated neurotoxicity syndrome (ICANS) during treatment with tisagenlecleucel or axicabtagene ciloleucel for large B-cell lymphoma (LBCL) or chronic lymphocytic leukaemia (CLL) [ I routes, dosages and durations of treatment to reactions onset not stated i ]. [Extracted from the article]

B Author Information b An event is serious (based on the ICH definition) when the patient outcome is: * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important event In a single-center diagnostic/prognostic accuracy study involving 204 patients conducted between April 2015 to February 2020 in USA, three patients were described [ I ages and sexes not stated i ], all the patients developed cytokine storm syndrome (CRS) during treatment with axicabtagene-ciloleucel for relapsed or refractory lymphoma. Additionally, the patients developed grade 2, grade 3 or grade 4 neurotoxicity during treatment with axicabtagene-ciloleucel for relapsed or refractory lymphoma and tocilizumab for CRS [ I routes and dosages not stated i ]. However, treatment with tocilizumab along with ongoing therapy of axicabtagene-ciloleucel resulted in development of grade 2 to neurotoxicity (1 patient), grade 3 neurotoxicity (1 patient) and grade 4 neurotoxicity (1 patient) [ I duration of treatment to reaction onset and outcomes not stated i ]. [Extracted from the article]

The other two patients, who received bridging radiation therapy and CAR T-cell infusion developed grade 3-4 immune effector cell-associated neurotoxicity syndrome (one patient) or grade 1-2 immune effector cell-associated neurotoxicity syndrome (one patient) [ I outcomes not stated i ]. B Author Information b An event is serious (based on the ICH definition) when the patient outcome is: * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important event In a single-institution retrospective review of patients with relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL), who received received CAR T-cell therapy, four patients [ I ages and sexes not stated i ] were described, who developed immune effector cell-associated neurotoxicity syndrome (three patients) or immune effector cell-associated neurotoxicity syndrome and cytokine release syndrome (one patient) following infusion of axicabtagene-ciloleucel. [Extracted from the article]

At the three-month follow-up, due to the persistent neutropenia and lymphopenia, antimicrobial therapy was continued with the plan to change cotrimoxazole to pentamidine. B Author Information b An event is serious (based on the ICH definition) when the patient outcome is: * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important event A 42-year-old man developed cytokine release syndrome (CRS), neurotoxicity and neutropenia during treatment with axicabtagene ciloleucel for refractory diffuse large B-cell lymphoma. [Extracted from the article]