SHM Converge Scientific Abstract ePoster Gallery-Calming a (Cytokine) Storm: Il-1 Blockade for Car-T Therapy Toxicities

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This case describes a 53-year-old woman with refractory stage IV diffuse large B-cell lymphoma who underwent CD19-directed CAR-T therapy (Yescarta) after failing multiple prior chemotherapy regimens. Although CAR-T can be highly effective, it may cause serious inflammatory toxicities, especially cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).<br /><br />In this patient, CRS began unusually early, with high fever on day 1 after infusion and persistent hyperthermia reaching 105.4°F. She initially received standard treatment with tocilizumab, the first-line therapy for CAR-T-related CRS, along with supportive care and antibiotics. Despite repeated doses of tocilizumab and later dexamethasone, she continued to have severe fevers and remained at risk for deterioration.<br /><br />On day 4, after her temperature stayed near 104–105°F, she was given 100 mg subcutaneous anakinra, an IL-1 receptor antagonist typically used when CRS or ICANS is refractory to tocilizumab and corticosteroids. Her fever improved that day. However, later on day 4 she developed abrupt neurologic decline, with her ICE score falling from 10 to 0, consistent with grade 4 ICANS. She was started on methylprednisolone, transferred to the ICU for neurocritical monitoring, and later improved; her ICE score returned to normal by day 6. She was discharged home on day 12.<br /><br />The authors emphasize that this case suggests a possible role for anakinra in refractory CAR-T toxicities, but questions remain about the best timing and dose. They also raise the possibility that earlier or higher-dose anakinra might have prevented progression to severe toxicity.

Asset Subtitle

Alexander T. Lo

Meta Tag

Author List Alan Moazzam, Alexander T. Lo, Dan Kaufman, Sutton Fox

Category Clinical Vignettes

Concept CAR-T Therapy Toxicity

Concept Cytokine Release Syndrome

Concept Immune Effector Cell-Associated Neurotoxicity Syndrome

Concept Tocilizumab

Concept Corticosteroid

Distinguished Non-Finalist

Presenter Organization University of California San Diego

Presenting Author Alexander T. Lo

Track Adult

Keywords

CAR-T therapy

diffuse large B-cell lymphoma

cytokine release syndrome

ICANS

tocilizumab

anakinra

refractory toxicity

methylprednisolone

immune effector cell

Yescarta

CAR-T Therapy Toxicity

Cytokine Release Syndrome

Immune Effector Cell-Associated Neurotoxicity Syndrome

Tocilizumab

Corticosteroid