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Abstract Details

Anakinara to mitigate CAR T cell therapy associated toxicity
General Neurology
N4 - Neuroscience in the Clinic: CAR-T Cell Therapy: Neurologic Applications and Neurotoxicity (6:15 PM-6:30 PM)
002
Evaluate the safety and clinical response to the use Anakinra (IL-1 receptor antagonist) in mitigating ICANS(Immune effector cell-associated neurotoxicity syndrome)

Patients receiving CAR T cell therapy experience ≥ grade 3 CRS (cytokine release syndrome) and ICANS that is treated with steroids. Minimizing the detrimental effects of steroids on CAR T cells, reduce life threating infections with steroid sparing agents are much needed. While tocilizumab is used for CRS with clinical benefit, steroid sparing agents for ICANS are pending for more widespread use.

Anakinra was tried in 6 patients (4 with Diffuse DLBCL and 2 with transformed follicular lymphoma). Anakinra was used in grade 3-4 ICANS with start day of 6-41 days. 100 mg dose was used for 5-7 doses. All patients continued to receive corticosteroids for a cumulative dexamethasone equivalent of 722 mg. 

An unpaired Student t test was used for area-under-the-curve comparisons. 4 patients had a clinical response (improvement to lower grades) after initiation of anakinra and 2 patients were refractory.  While there is a trend towards benefit, given the small number no clear conclusion can be drawn.

 
This small cohort establishes safety in the use of anakinra for ICANS. Timing the anakinra doses towards prevention by earlier use rather than after established higher grades makes a better strategy as is currently being studied.
Authors/Disclosures
Sudhakar Tummala, MD, FÂ鶹´«Ã½Ó³»­ (MD Anderson Cancer Center)
PRESENTER 		Dr. Tummala has nothing to disclose.