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ORIGINAL RESEARCH article

Front. Immunol.
Sec. T Cell Biology
Volume 15 - 2024 | doi: 10.3389/fimmu.2024.1448709

The influence of CRS and ICANS on the efficacy of anti-CD19 CAR-T treatment for B-cell acute lymphoblastic leukemia

Provisionally accepted
Yuhan Ma Yuhan Ma 1Hongyuan Zhou Hongyuan Zhou 2,3Jiaoli Zhang Jiaoli Zhang 4Qing Zhang Qing Zhang 2,3Yujie Li Yujie Li 2,3Ruiyang Xie Ruiyang Xie 2,3Bingpei Zhang Bingpei Zhang 2,3Ziyuan Shen Ziyuan Shen 5Ping Li Ping Li 6Aibin Liang Aibin Liang 6Ke-Shu Zhou Ke-Shu Zhou 7Lu Han Lu Han 7Yongxian Hu Yongxian Hu 8Kailin Xu Kailin Xu 3,9Wei Sang Wei Sang 2,3*Xiangmin Wang Xiangmin Wang 2,3*
  • 1 Department of Hematology, Suqian First Hospital, Suqian, China
  • 2 Department of Hematology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
  • 3 Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu Province, China
  • 4 Department of Rehabilitation Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
  • 5 Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui Province, China
  • 6 Department of Hematology, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
  • 7 Department of hematology, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
  • 8 Department of Hematology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Hangzhou, China
  • 9 Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China

The final, formatted version of the article will be published soon.

    Background: Chimeric antigen receptor T cell (CAR-T) therapy has offered new opportunities for patients with relapsed/refractory B cell lymphoblastic leukemia (r/r B-ALL). However, cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are the two most common toxicities following CAR-T cell therapy. At present, whether the occurrence of CRS and ICANS will impact CAR-T activity remains unknown; this affects the therapeutic efficacy of CAR-T. Methods: In this multicenter retrospective study, we enrolled 93 patients with r/r B-ALL receiving anti-CD19 CAR-T cell therapy at four medical centers. We evaluated their complete response (CR) rates, MRD-negative CR rates, and survival outcomes. Results: Among the included patients, 76 (81.7%) developed CRS and 16 (5.3%) developed ICANS. Fifteen patients experienced concurrent CRS and ICANS. However, no significant differences were noted in CR or MRD-negative CR rates between patients with and without CRS/ICANS. Furthermore, no significant difference was noted in leukemia-free survival (LFS) (p = 0.869 for CRS and p = 0.276 for ICANS) or overall survival (OS) (p = 0.677 for CRS and p = 0.326 for ICANS) between patients with and without CRS/ICANS. Similarly, patients with concurrent CRS and ICANS exhibited no differences in OS and LFS when compared with other patients. Multivariate analysis showed that the development of CRS and ICANS was not associated with any difference in OS and LFS. Conclusion: Patients with CRS/ICANS experience similar clinical outcomes compared with those without CRS/ICANS following anti-CD19 CAR-T therapy.

    Keywords: cytokine release syndrome, Immune Effector Cell-Associated Neurotoxicity Syndrome, chimeric antigen receptor T cell therapy, relapsed/refractory B cell lymphoblastic leukemia, efficacy

    Received: 13 Jun 2024; Accepted: 09 Sep 2024.

    Copyright: © 2024 Ma, Zhou, Zhang, Zhang, Li, Xie, Zhang, Shen, Li, Liang, Zhou, Han, Hu, Xu, Sang and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Wei Sang, Department of Hematology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
    Xiangmin Wang, Department of Hematology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.