Corticosteroids do not influence the efficacy and kinetics of CAR-T cells for B-cell acute lymphoblastic leukemia

Chimeric antigen receptor (CAR) T-cell therapy has been demonstrated as a promising immunotherapeutic approach for treating the patients with relapsed/refractory B-cell acute lymphoblastic leukemia (B-ALL) 1 , 2 , 3 . However, cytokine release syndrome (CRS), the most prominent toxicity of CAR-T cell therapy, could be serious and even life-threatening 4 , 5 . Tocilizumab, an IL-6 receptor antagonist, has been widely used to treat CRS-related toxicities 5 , 6 , 7 , although corticosteroids could effectively abrogate CRS as well 4 , 5 , several earlier cases showed steroids may inhibit CAR T-cell persistence and their antimalignancy efficacy 7 , 8 , making corticosteroid therapy in CRS be often reserved for failure of tocilizumab or for neurologic toxicity since tocilizumab could not cross the blood-brain barrier. In our center, we use corticosteroids instead of tocilizumab as the first-line agent to manage CRS, here, we assessed the influence of steroids on the treatment effect and kinetics of CAR-T cells by comparing the difference between two groups of B-ALL patients who did (42 cases) or did not (26 cases) accept steroids.