Title

Prognostic Impact of Corticosteroids on Efficacy of Chimeric Antigen Receptor T-cell Therapy in Large B-cell Lymphoma

Authors

Paolo Strati, MD Anderson Cancer Center, Houston, Texas
Sairah Ahmed, University of Texas, MD Anderson Cancer Center
Fateeha Furqan, Rochester General Hospital
Luis E. Fayad, University of Texas M.D. Anderson Cancer Center, Houston, Texas
Hun Ju Lee, MD Anderson Cancer Center, Houston, Texas
Swaminathan P. Iyer, MD Anderson Cancer Center, Houston, Texas
Ranjit Nair, MD Anderson Cancer Center, Houston, Texas
Loretta Nastoupil, University of Texas M.D. Anderson Cancer Center, Houston, Texas
Simrit Parmar, MD Anderson Cancer Center, Houston, Texas
Maria A. Rodriguez, MD Anderson Cancer Center, Houston, Texas
Felipe Samaniego, University of Texas MD Anderson Cancer Center, Houston, Texas
Raphael E. Steiner, MD Anderson Cancer Center, Houston, Texas
Michael L. Wang, University of Texas M.D. Anderson Cancer Center, Houston, Texas
Chelsea C. Pinnix, MD Anderson Cancer Center, Houston, Texas
Sandra B. Horowitz, UT MD Anderson Cancer Center, Houston, Texas
Lei Feng, UT MD Anderson Cancer Center, Houston, Texas
Ryan Sun, UT MD Anderson Cancer Center, Houston, Texas
Catherine M. Claussen, MD Anderson Cancer Center, Houston, Texas
Misha Hawkins, MD Anderson Cancer Center, Houston, Texas
Nicole Johnson, MD Anderson Cancer Center, Houston, Texas
Prachee Singh, MD Anderson Cancer Center, Houston, Texas
Haleigh Mistry, MD Anderson Cancer Center, Houston, Texas
Swapna Johncy, MD Anderson Cancer Center, Houston, Texas
Sherry Adkins, MD Anderson Cancer Center, Houston, Texas
Partow Kebriaei, University of Texas MD Anderson Cancer Center, Houston, Texas
Elizabeth J. Shpall, MD Anderson Cancer Center, Houston, Texas
Michael R. Green, University of Texas MD Anderson Cancer Center, Houston, Texas
Christopher Flowers, University of Texas MD Anderson Cancer Center, Houston, Texas
Jason Westin, University of Texas MD Anderson Cancer Center, Houston, Texas
Sattva S. Neelapu, University of Texas MD Anderson Cancer Center, Houston, Texas

Department

Oncology and Hematology

Document Type

Article

Publication Title

Blood

Abstract

Corticosteroids are commonly used for the management of severe toxicities associated with chimeric antigen receptor (CAR) T-cell therapy. However, it remains unclear whether their dose, duration, and timing may impact clinical efficacy. Here, we determined the impact of corticosteroids on clinical outcomes in patients with relapsed or refractory large B-cell lymphoma treated with standard of care anti-CD19 CAR T-cell therapy. Among 100 patients evaluated, 60 (60%) received corticosteroids for management of CAR T-cell therapy-associated toxicities. The median cumulative dexamethasone-equivalent dose was 186 mg (range, 8-1803 mg) and the median duration of corticosteroid treatment was 9 days (range 1-30). Corticosteroid treatment was started between days 0 and 7 in 45 (75%) patients and beyond day 7 in 15 (25%). After a median follow-up of 10 months (95% CI 8-12 months), use of higher cumulative dose of corticosteroids was associated with significantly shorter progression-free survival. More importantly, higher cumulative dose of corticosteroids, and prolonged and early use after CAR T-cell infusion were associated with significantly shorter overall survival. These results suggest that corticosteroids should be used at the lowest dose and for the shortest duration and their initiation should be delayed whenever clinically feasible, while managing CAR T-cell therapy-associated toxicities.

DOI

10.1182/blood.2020008865

Publication Date

2-3-2021

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