The following article features coverage from the American Society of Clinical Oncology 2020 meeting. Click here to read more of Hematology Advisor’s conference coverage.
Hemophagocytic lymphohistiocytosis (HLH) may be a serious and underreported adverse event associated with chimeric antigen receptor (CAR)-T cell therapy among patients with large B-cell lymphoma, according to research presented during the ASCO20 Virtual Scientific Program.
HLH, which is characterized by severe immune activation and immune-related organ failure, is a rare but serious event associated with CAR-T cell treatment. Diagnosis can be difficult and the best course of treatment is not always clear.
A team of researchers evaluated data from 105 patients with relapsed/refractory large B-cell lymphoma to determine the incidence and clinical significance of HLH after CAR-T therapy. All patients had received standard of care axicabtagene ciloleucel.
Overall, 6 patients developed HLH and 99 did not. The average ages for patients in the HLH and no-HLH groups were 61 years and 60 years, respectively. HLH development occurred at a median of 11 days after CAR-T cell infusion (range, 7-78 days). No baseline characteristics differed between the 2 groups.
All 6 patients with HLH had abnormal liver function test results; 4 of the 6 patients had grade 0 or 1 cytokine release syndrome, and 1 had grade 2. In addition, 3 of the patients had grade 3 or 4 immune effector cell–associated neurotoxicity syndrome.
Five of the patients with HLH received high-dose steroids and tocilizumab, while 2 patients received anakinra; 4 of the patients did not require further HLH-specific therapy.
At a follow-up of 10 months, progression-free and overall survival (PFS and OS, respectively) were worse in the HLH group. PFS was 1 month vs 8 months in the no-HLH group (P <.001), while OS was 2 months vs not reached (P =.001).
In the HLH group, 1 patient died of acute respiratory failure, 2 died of HLH, and the remaining 3 had progressive disease by day 30. Two of these patients died of progressive disease.
“HLH is likely an underreported complication of CART cell therapy, and patients with HLH have significantly worse outcomes,” the authors wrote. “In this series the majority of patients died of [progressive disease], not the syndrome itself. More information is necessary to design treatment strategies that won’t compromise CART outcomes.”
Ahmed S, Furqan F, Strati P, et al. Haemophagocytic lymphohistiocytosis (HLH) in patients with large B-cell lymphoma treated with standard of care (SOC) axicabtagene ciloleucel (Axi-cel). Presented at: ASCO20 Virtual Scientific Program. J Clin Oncol. 2020;38(suppl):abstr 8057.