Proton pump inhibitors and outcome after axicabtagene ciloleucel for the treatment of non-Hodgkin B-cell lymphoma, a retrospective study with the DESCAR-T registry

Axicabtagene ciloleucel (axi-cel), an autologous anti-CD19 chimeric antigen receptor CAR T-cell (CAR-T), is a major second- or third-line treatment in refractory or early relapsed large B-cell lymphoma (LBCL), primary mediastinal large B-cell lymphoma (PMBL) and follicular lymphoma (FL) [ 1 ]. Although axi-cel induces high complete response rates in relapsed or refractory LBCL, PMBL, and FL, relapse remains the leading cause of treatment failure. Long-term follow-up from ZUMA-1 and ZUMA-5 demonstrates that most progression events occur within the first years after CAR-T infusion [ 2 , 3 ]. Adverse events include cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and infections, associated with increased morbidity and mortality. Understanding the determinants underlying toxicity and relapse is crucial to improve patient outcomes, optimize treatment strategies, and reducing disease burden.