Effect of early granulocyte-colony-stimulating factor administration in the prevention of febrile neutropenia and impact on toxicity and efficacy of anti-CD19 CAR-T in patients with relapsed/refractory B-cell lymphoma

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Liévin, Raphaël | Di Blasi, Roberta | Morin, Florence | Galli, Eugenio | Allain, Vincent | de Jorna, Romain | Vercellino, Laetitia | Parquet, Nathalie | Mebarki, Miryam | Larghero, Jerome | de Kerviler, Eric | Madelaine, Isabelle | Caillat-Zucman, Sophie | Chevret, Sylvie | Thieblemont, Catherine

Edité par CCSD ; Nature Publishing Group -

International audience. Abstract Chimeric Antigen Receptor T cells (CAR-T) are an outbreaking treatment option for relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL). Cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are the most common specific toxicities, while severe neutropenia and infections are often observed as well. From March 2020, early G-CSF prophylaxis at day (D) two post-infusion was systematically proposed. We then compared patients treated before that date who did not receive G-CSF or who received late (after D5) G-CSF as control group. Patients administered with early G-CSF had similar duration of grade 4 neutropenia but significantly decreased incidence of febrile neutropenia (58% versus 81%, p = 0.018). Similar rate of toxicities was observed, including overall and grade 3-4 CRS ( p = 0.93 and p = 0.28, respectively), and overall and grade 3-4 ICANS ( p = 0.62 and p = 0.88, respectively). We observed no difference in the quality of CAR T-cells expansion ( p = 0.79, %Cmax), nor in response rate (best ORR, 57.6% vs 61.8%, p = 0.93), nor survival even in a group of patients adjusted by a propensity score. In conclusion, early G-CSF administration was safe and effective in reducing febrile neutropenia without impact on toxicities nor on anti-lymphoma activity of CAR-T.

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