Characterization of cytokine release syndrome (CRS) and neurological events (NEs) in the phase I TRANSCEND NHL 001 trial of lisocabtagene maraleucel (liso-cel) for patients (pts) with relapsed/refractory (R/R) large B-cell lymphoma (LBCL).

Authors

null

Jeremy S. Abramson

Massachusetts General Hospital Cancer Center, Boston, MA

Jeremy S. Abramson , Tanya Siddiqi , Leo I. Gordon , Matthew Alexander Lunning , Michael Wang , Jon E. Arnason , Amitkumar N. Mehta , Enkhee Purev , David G. Maloney , Charalambos Andreadis , Alison R. Sehgal , Scott R. Solomon , Nilanjan Ghosh , Tina M. Albertson , Jacob Garcia , Ana Kostic , Daniel Li , Yeonhee Kim , Maria Lia Palomba

Organizations

Massachusetts General Hospital Cancer Center, Boston, MA, City of Hope National Medical Center, Duarte, CA, Northwestern University, Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, University of Nebraska Medical Center, Omaha, NE, The University of Texas MD Anderson Cancer Center, Houston, TX, Beth Israel Deaconess Medical Center, Boston, MA, University of Alabama at Birmingham School of Medicine, Birmingham, AL, University of Colorado School of Medicine, Aurora, CO, Fred Hutchinson Cancer Research Center, Seattle, WA, University of California at San Francisco, San Francisco, CA, University of Pittsburgh Medical Center, Pittsburgh, PA, Immunotherapy Program, Northside Hospital Cancer Institute, Atlanta, GA, Levine Cancer Institute, Atrium Health, Charlotte, NC, Juno Therapeutics, a Bristol-Myers Squibb company, Seattle, WA, Memorial Sloan Kettering Cancer Center, New York, NY

Research Funding

Other
Juno Therapeutics, a Bristol-Myers Squibb company

Background: Clinical studies of liso-cel show low incidences of severe CRS and NEs. Pts with high tumor burden and inflammation are at higher risk of CRS and NEs (Borrega, Hemasphere 2019). Here, we characterize the presenting symptoms, timing, and management of CRS and NEs in pts with R/R LBCL treated with liso-cel in TRANSCEND NHL 001 (NCT02631044). A deeper understanding of CRS/NEs after liso-cel treatment may help clinicians identify and manage these toxicities. Methods: Pts with R/R LBCL and ≥2 lines of therapy received liso-cel after lymphodepletion (LD) with fludarabine and cyclophosphamide. Bridging therapy was allowed for pts with PET-positive disease before LD (Abramson, ASH 2019 #241). Investigators were educated on prospectively identifying liso-cel–related NEs and CRS, which were collected and graded per NCI CTCAE v4.03 (NEs) or 2014 Lee criteria (CRS). Timing and severity of individual CRS/NE symptoms and interventions were also collected. Results: The analysis included 269 pts (median age, 63 y): 38% had sum of perpendicular diameters ≥50 cm2 or lactate dehydrogenase ≥500 U/L, and 59% received bridging therapy. CRS and NEs had delayed onset (median, 5 and 9 d, respectively) and a low incidence of grade (Gr) ≥3 events (CRS 2%; NE 10%). CRS occurred before NEs in most pts and was Gr 1/2 at onset in all but 2 pts (Table). The most common CRS symptoms were pyrexia (40%), hypotension (20%), and tachycardia (18%). Overall, 20% of pts received tocilizumab and/or corticosteroids for CRS (10% tocilizumab only; 2% corticosteroids only; 8% both); 3% received vasopressors. The most common NE symptoms were confusional state (11%), tremor (9%), and aphasia (8%); most were low grade. A total of 17% of pts received tocilizumab and/or corticosteroids for NEs (13% corticosteroids only; < 1% tocilizumab only; 3% both); < 1% received vasopressors. Overall, 4% of pts were admitted to the ICU for CRS and/or NEs. Additional analyses on timing of intervention and type/severity of initial symptoms will be presented. Conclusions: In pts with high-risk, aggressive R/R LBCL, liso-cel treatment was associated with a low incidence of severe CRS/NEs, late onset of mostly low-grade events at presentation, and low use of tocilizumab/corticosteroids. Clinical trial information: NCT02631044.

CRS/NE Summary (N = 269).

CRSNEs
All grades, n (%)113 (42)80 (30)
Maximum Gr ≥36 (2)27 (10)
Gr 500
Time to onset, median (range), d5 (1‒14)9 (1‒66)
Time to resolution, median (range), d5 (1‒17)11 (1‒86)

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Abstract Details

Meeting

2020 ASCO Virtual Scientific Program

Session Type

Publication Only

Session Title

Publication Only: Hematologic Malignancies—Lymphoma and Chronic Lymphocytic Leukemia

Track

Hematologic Malignancies

Sub Track

Non-Hodgkin Lymphoma

Clinical Trial Registration Number

NCT02631044

Citation

J Clin Oncol 38: 2020 (suppl; abstr e20046)

DOI

10.1200/JCO.2020.38.15_suppl.e20046

Abstract #

e20046

Abstract Disclosures