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Gavriilaki E, Mallouri D, Bousiou Z, Demosthenous C, Vardi A, Dolgyras P, Batsis I, Stroggyli E, Karvouni P, Masmanidou M, Gavriilaki M, Bouinta A, Bitsianis S, Kapravelos N, Bitzani M, Vasileiadou G, Yannaki E, Sotiropoulos D, Papagiannopoulos S, Kazis D, Kimiskidis V, Anagnostopoulos A, Sakellari I. Molecular and Clinical Characteristics of Different Toxicity Rates in Anti-CD19 Chimeric Antigen Receptor T Cells: Real-World Experience. Cancers (Basel) 2023; 15:4253. [PMID: 37686529 PMCID: PMC10487155 DOI: 10.3390/cancers15174253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Commercially available anti-CD19 chimeric antigen receptor T cells (CARΤ cells) have offered long-term survival to a constantly expanding patient population. Given that novel toxicities including cytokine release syndrome (CRS) and neurotoxicity (ICANS) have been observed, we aimed to document the safety and toxicity of this treatment in a real-world study. We enrolled 31 adult patients referred to our center for CAR T therapy. Tisagenlecleucel was infused in 12 patients, axicabtagene ciloleucel in 14, and brexucabtagene autoleucel in 5. Cytokine release syndrome was noted in 26 patients while neurotoxicity was observed in 7. Tocilizumab was administered for CRS in 18 patients, along with short-term, low-dose steroid administration in one patient who developed grade III CRS and, subsequently, grade I ICANS. High-dose steroids, along with anakinra and siltuximab, were administered in only two MCL patients. With a median follow-up time of 13.4 months, nine patients were then in CR. The progression-free (PFS) and overall survival (OS) rates were 41.2% and 88.1% at one year, respectively. MCL diagnosis, which coincides with the administration of brexucabtagene autoleucel, was the only factor to be independently associated with poor OS (p < 0.001); meanwhile, increased LDH independently predicted PFS (p = 0.027).In addition, CRP at day 14 was associated with a poor OS (p = 0.001). Therefore, our real-world experience confirmed that commercial CAR T therapy can be administered with minimal toxicity.
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Affiliation(s)
- E. Gavriilaki
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
- Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - D. Mallouri
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
| | - Z. Bousiou
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
| | - C. Demosthenous
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
| | - A. Vardi
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
| | - P. Dolgyras
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
| | - I. Batsis
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
| | - E. Stroggyli
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
| | - P. Karvouni
- Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - M. Masmanidou
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
| | - M. Gavriilaki
- 1st Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.G.); (V.K.)
| | - A. Bouinta
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
| | - S. Bitsianis
- Department of Surgery, G. Papanicolaou Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - N. Kapravelos
- 1st Intensive Care Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (N.K.); (G.V.)
| | - M. Bitzani
- 2nd Intensive Care Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (M.B.); (S.P.)
| | - G. Vasileiadou
- 1st Intensive Care Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (N.K.); (G.V.)
| | - E. Yannaki
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
| | - D. Sotiropoulos
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
| | - S. Papagiannopoulos
- 2nd Intensive Care Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (M.B.); (S.P.)
| | - D. Kazis
- 3rd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - V. Kimiskidis
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
- 1st Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.G.); (V.K.)
| | - A. Anagnostopoulos
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
| | - I. Sakellari
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
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