Filgrastim associations with CAR T-cell therapy

Area of Science:

• Oncology
• Immunotherapy
• Hematology

Background:

• Chimeric antigen receptor (CAR) T-cell therapy is a promising treatment for relapsed/refractory diffuse large B-cell lymphoma (DLBCL).
• The role of myeloid growth factors, such as filgrastim, after CAR T-cell therapy is not well-established.
• Understanding the benefits and risks of filgrastim in this setting is crucial for optimizing patient care.

Purpose of the Study:

• To evaluate the impact of filgrastim administration on neutropenia duration, infection rates, and the incidence and severity of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) after CAR T-cell therapy in DLBCL patients.
• To determine if filgrastim use influences key safety outcomes post-CAR T-cell therapy.

Main Methods:

• Retrospective analysis of 22 patients with relapsed/refractory DLBCL who received axicabtagene ciloleucel CAR T-cell therapy.
• Patients were divided into two groups: those who received filgrastim and those who did not.
• Outcomes assessed included duration of neutropenia, infection rates, and incidence/severity of CRS and ICANS.

Main Results:

• Filgrastim significantly reduced the median duration of neutropenia (5 vs. 15 days, P = .016).
• There was no significant difference in infection incidence or severity between groups (P = .274, P = .138).
• While CRS and ICANS incidence did not differ, filgrastim use was associated with a significant increase in CRS severity (P = .042).

Conclusions:

• Filgrastim administration after CAR T-cell therapy in DLBCL patients may shorten neutropenia but does not appear to decrease infection rates.
• A notable finding is the potential for increased severity of cytokine release syndrome (CRS) with filgrastim use.
• These findings suggest a cautious approach to filgrastim use post-CAR T-cell therapy, balancing potential benefits against risks of severe CRS.