Giving steroids to patients with relapsed/refractory high-grade B-cell non-Hodgkin’s lymphoma (B-NHL) following chimeric antigen receptor (CAR) T-cell therapy may place them at substantially increased risk of infection, suggests a real-world analysis of UK patient data.
The analysis also indicated that patients who have undergone multiple prior lines of chemotherapy are also at particular risk after receiving the treatment.
The research was presented at the virtual 62nd ASH Annual Meeting and Exposition on December 7.
Dr Lorna Neill, Department of Haematology, University College London Hospitals NHS Foundation Trust, and colleagues looked at the records of 60 high-grade B-NHL patients given CAR-T cell therapy, more than a third of whom had received at least three prior lines of therapy.
Almost half of the patients developed an infection within 30 days of receiving treatment, the majority bacterial in nature. Over half also developed cytokine release syndrome (CRS) and a quarter severe immune effector cell-associated neurotoxicity syndrome (ICANS).
Analysis showed the risk of infection following CAR T-cell therapy was increased 4.3-fold in patients who had received at least three prior lines of therapy, while steroid use increased the risk by a factor of 3.8.
Presenting the results, Dr Neill said that the rate of early infections post-CAR T-cell infusion is “comparable with other cohorts”.
However, she noted that, “unlike in some US centres, this cohort did not receive prophylactic antibiotics or intravenous immune globulin”.
Dr Neill continued: “Clearly, patients with advanced disease with high-grade lymphoma are at high-risk for CRS and ICANS, which increases the use of steroids and appears to lead to infectious complications,” Dr Neill added.
“Heavy pre-treatment may also increase the risks by intensifying immunosuppression prior to CAR T-cell therapy”, and “strategies to modulate these risks include optimisation of [chemotherapy] bridging to reduce the disease burden…combined with infectious prophylaxis from referral until at least 3 to 6 months post-infusion.”
She said: “In this analysis, steroids represent a significant risk and efforts should be made to wean doses swiftly,” while the use of steroid-sparing agents “may be important and clinical trial results are awaited”.
Dr Catherine Diefenbach, director, Clinical Lymphoma Program at NYU Langone’s Perlmutter Cancer Center, New York, USA, who was not involved in the study, told Medscape News UK that infections post-CAR T-cell therapy “is a real-world issue”.
However, she said that it