Evaluating Early Steroid and Anakinra Use for Managing Axi-Cel Toxicity
Wang WL, Lee D, Cheung E, et al. Early Steroid and Anakinra Use to Manage Axicabtagene Ciloleucel Toxicity Reduces the Total Duration of CRS and ICANS. Blood Advances. 2026; (doi: 10.1182/bloodadvances.2025019031).
Toxicities related to axicabtagene ciloleucel (axi-cel) can be safely and effectively managed, suggest findings from a single-center study. The chimeric antigen receptor (CAR) T-cell therapy works against relapsed or refractory large B-cell lymphoma (LBCL), but its efficacy may be offset by the development of cytokine release syndrome (CRS) and/or immune effector cell-associated neurotoxicity syndrome (ICANS). Researchers explored the viability of a toxicity management protocol based on earlier administration of steroids and use of anakinra, which was evaluated as an alternative to standard tocilizumab use. The retrospective study included 103 patients with relapsed or refractory LBCL who were treated for axi-cel toxicity after the new protocol was implemented in 2020 and 92 patients who were treated before then. While overall CRS and ICANS rates were not meaningfully different between groups, significantly shorter durations for both conditions were documented in participants in the intervention arm. Other efficacy outcomes, intensive care unit admission rates, and hospital length of stay were comparable in the intervention and comparator groups. Collectively, the researchers say the findings support earlier intervention for CAR-T toxicities and establish anakinra as a safe and effective alternative to tocilizumab for toxicity management.