Dynamic risk stratification using early CAR-T expansion in R/R LBCL treated with axicabtagene ciloleucel
- Author(s)
- Panozzo, B; Robinson, S; Minson, AG; Li, J; Baldwin, K; Scott, HW; Oliaro, J; Wong, AJN; Van Der Linde, S; O'Leary, NL; Thompson, PA; Seymour, JF; Anderson, MA; Tam, CS; Harrison, SJ; Dickinson, MJ; Westerman, DA; Dowling, MR;
- Journal Title
- British Journal of Haematology
- Publication Type
- Online publication before print
- Abstract
- The clinical utility of routine monitoring of chimeric antigen receptor (CAR) T-cell expansion post-infusion remains controversial. We conducted a retrospective analysis of a prospectively collected cohort of 176 patients with relapsed/refractory large B-cell lymphoma (LBCL) treated with axicabtagene ciloleucel (axi-cel). CAR T-cell expansion was measured by flow cytometry at days 7, 14 and 28 following infusion with real-time reporting to the clinical service in 111 patients. We examined the association between CAR T-cell expansion, efficacy (progression-free survival [PFS]), toxicity (cytokine release syndrome [CRS] and immune effector cell-associated neurotoxicity syndrome [ICANS]) and toxicity management, accounting for baseline risk factors. A multivariable model combining day 7 expansion with pre-lymphodepletion lactate dehydrogenase (LDH) and bridging response demonstrated that robust day 7 expansion (≥48 cells/μL) was independently associated with improved PFS (hazard ratio [HR], 0.43; 95% confidence interval [CI] 0.22-0.83; p = 0.01). Higher day 7 expansion was associated with increased CRS severity and ICANS incidence. Higher corticosteroid exposure reflected this toxicity burden but was not associated with inferior PFS. Thus, incorporating quantitative CAR-T enumeration into clinical practice may dynamically refine risk stratification post-infusion and guide individualised management, such as the frequency of monitoring for progressive disease in the era of effective subsequent therapies.
- Keywords
- cellular therapy; lymphoid neoplasia
- Department(s)
- Haematology; Pathology; Laboratory Research; Cancer Imaging
- Publisher's Version
- https://doi.org/10.1111/bjh.70825
- Open Access at Publisher's Site
https://doi.org/10.1111/bjh.70825- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2026-10-12 05:40:49
Last Modified: 2026-10-12 05:41:16