Toxicity Risks Manageable But High after CD19-Directed CAR T-Cell Therapy for DLBCL

A study published in Blood Advances assessed patients with diffuse large B-cell lymphoma (DLBCL) treated with CD19-directed chimeric antigen receptor (CAR) T-cell therapy and found that while the toxicity profile was manageable, the toxicity burden was high and varied by organ systems.

Researchers analyzed organ-specific toxicities and outcomes in 60 patients with DLBCL treated with CD19-directed CAR T-cell therapy during the first year of post-treatment.

There were 539 grade ≥2 and 289 grade ≥3 toxicities. Common grade ≥3 toxicities included hematological, metabolic, infectious, and neurological complications, with one-year cumulative incidences of 57.7%, 54.8%, 35.4%, and 18.3%, respectively.

Patients with impaired performance status had a higher risk of grade ≥3 metabolic complications, while elevated lactate dehydrogenase was associated with higher risks of grade ≥3 neurological and pulmonary toxicities. Furthermore, cytokine release syndrome was correlated with higher incidence of grade ≥3 metabolic, pulmonary, and neurologic complications. One-year non-relapse mortality was 1.7% and overall survival was 69.0%. Grade ≥3 pulmonary toxicities were associated with increased mortality.

“Our study emphasizes the importance of toxicity assessment, which could serve as a benchmark for further research to reduce symptom burdens and improve tolerability in patients treated with CAR T-cells,” the researchers concluded.