Real world experience of anakinra for the treatment of immune effector cell-associated neurotoxicity syndrome in large B-cell lymphoma

作者：Rahul K. Shah, Xiaowen Sun, Lei Feng, Anath C. Lionel, Zachary Hunzeker, Sairah Ahmed, Jeremy Ramdial, Michelly Abreu, Karla Ow, Minifrida Santiago, Jaimole Varghese, Sherry Adkins, Misha Hawkins, Sandra Horowitz, Amy Ayers, Partow Kebriaei, Elizabeth J. Shpall, Sattva S. Neelapu, Paolo Strati · 发表于：Blood · 年份：2025 · DOI：10.1182/blood-2025-6319 · 被引用次数：1 · 研究领域：CAR-T cell therapy research、Cancer Immunotherapy and Biomarkers、Cutaneous lymphoproliferative disorders research

Abstract Background Anakinra, an IL-1 receptor antagonist approved for rheumatologic conditions, has been increasingly used off-label as a corticosteroid-sparing agent for refractory cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) following chimeric antigen receptor T-cell therapy (CART). Preclinical models have demonstrated that anakinra may be effective for CRS and ICANS without compromising CAR T-cell function, and small retrospective studies support its safety in this setting. While anakinra has been shown to be effective in a fraction of cases of corticosteroid-refractory ICANS, real-world data remain limited, and the identification of clinical and laboratory factors to guide patient selection and optimal treatment initiation is warranted. Methods This is a retrospective single center analysis of patients with large B-cell lymphoma (LBCL) consecutively treated with anakinra for ICANS after standard of care anti-CD19 CART between February 2020 and November 2024. Responders were defined by ICANS resolution after initiation of anakinra. Baseline characteristics were collected pre-lymphodepletion. Serum inflammatory and tumor burden biomarkers were collected during the first 30 days after CART infusion. CRS and ICANS graded per ASTCT criteria; lymphoma response per Lugano 2014 criteria. Chi-square test or Fisher's exact test and Wilcoxon rank sum test were used for categorical and continuous variables, respectively. The area...