The following article features coverage from the American Society of Hematology 2019 Annual Meeting. Click here to read more of Oncology Nurse Advisor‘s conference coverage.

Cytokine release syndrome (CRS) is a potentially life-threatening inflammatory response caused by chimeric antigen receptor T-cell (CAR-T) therapy. The use of corticosteroids has been suggested as a possible method to mitigate this toxic response. Until now whether such use would compromise CAR-T treatment success has been unclear.

In a study presented at the 61st American Society of Hematology (ASH) Annual Meeting & Exposition, held in Orlando, Florida, researchers found that corticosteroid use did not influence the efficacy and kinetics of CAR-T cells in patients with relapsed/refractory B-cell acute lymphoblastic leukemia.1


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The study included 68 patients, 28 adults and 40 children younger than 18 years. Forty-two patients, including 10 patients with grade 3 CRS, 30 patients with grade 2 CRS, one patient with graft-versus-host disease (GVHD), and one patient with neurotoxicity, were administered dexamethasone and/or methylprednisolone.

Steroids were started at a low dose and were gradually increased if CRS symptoms did not resolve. Once CRS was improved, steroid treatment was gradually reduced and stopped. The effects of steroid use were evaluated 30 days after T-cell infusion and followed-up monthly. Twenty-six patients received only supportive care without steroids.

The researchers found no difference in complete remission rate between the steroid and nonsteroid group (92.2% vs 92.3%), indicating that even high-dose steroids did not interfere with treatment response. Patients who received steroids also had higher average CAR-T cell counts in peripheral blood at day 11 of treatment. Lastly, no significant differences in B-cell aplasia were noted in patients followed up more than 2 months posttreatment.

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Complete remission was still maintained in surviving patients more than 4 months post treatment. The authors concluded, “corticosteroids do not compromise the treatment efficacy and kinetics of CAR-T cells, [and] could be [used] as a feasible and effective approach to manage CAR-T associated CRS.”

Reference

Liu S, Deng B, Pan  J, et al. Corticosteroids do not influence the efficacy and kinetics of CAR-T cells for B-cell acute lymphoblastic leukemia. Oral presentation at: 61st ASH Annual Meeting & Exposition; December 7-10, 2019; Orlando, FL. Abstract 228.