Intravenous Immunoglobulin (IVIG) for Patients with Severe Neurotoxicity Associated with Chimeric Antigen Receptor T-Cell (CAR-T) Therapy

TL;DR

This study explores the use of IVIG as a treatment for severe neurotoxicity in patients undergoing CAR-T therapy for lymphoma.

Contribution

The study provides insights into the safety and potential efficacy of IVIG in managing severe ICANS in CAR-T-treated patients.

Findings

IVIG was found to be tolerable and safe in patients with severe ICANS.

Patients receiving IVIG had more severe ICANS grades at baseline.

There was no significant difference in time to resolution of ICANS between IVIG and glucocorticoids-only groups.

Abstract

Severe immune effector cell-associated neurotoxicity syndrome (ICANS) occurs in about 30% of all patients with large B-cell lymphoma (LBCL) who are treated with axicabtagene ciloleucel (axi-cel). There are currently limited treatment strategies other than the standard corticosteroids, and it is essential to find additional therapies to manage severe ICANS. We conducted a retrospective study of neurologic outcomes among patients who received axi-cel for LBCL from May 2015 to February 2019. We identified patients who developed severe ICANS and were treated with glucocorticoids followed by intravenous immunoglobulin (IVIG) (n  =  9) or glucocorticoids alone (n  =  10). There was no statistically significant difference in the time to resolution (TTR) of severe ICANS between groups; however, patients in the IVIG had more severe grades of ICANS with a lower performance status at baseline. The cumulative steroid days were 11.2 in the IVIG arm and 13.5 in the glucocorticoids-only arm. The use of IVIG for severe ICANS after axi-cel therapy was tolerable and safe and is generally recommended in the CAR-T setting in patients with hypogammaglobinemia. The use of IVIG as a potential therapeutic agent for severe ICANS can be further explored in future prospective studies.

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