Key points are not available for this paper at this time.
Background: Predicting CRS and ICANS prior to CAR-T infusion is desirable as it may help to plan management. Two groups1,2 have recently shown that a modification of the Endothelial Activation and Stress Index (EASIX) score, developed to predict toxicity in bone marrow transplant recipients3, can predict CRS and ICANS severity in CAR-T patients, however these have not been externally validated or are difficult to apply in practice. Aims: We aimed to determine whether the EASIX or related scores could predict CAR-T toxicity in our patients and if not, then to identify other potential predictors from the available clinical information. Methods: We reviewed the medical records of adult patients who received axicabtagene ciloleucel (axi-cel) as standard of care at our centre over a 2yr period, collecting data on timing and severity of CRS and ICANS as well as baseline demographic and biochemical factors. We calculated an EASIX score for all patients and an ‘EASIX-F’ score based on the values provided by Greenbaum et al (EASIX-F1) and our own interquartile values (EASIX-F2). We then performed a linear regression of each of: the EASIX score; EASIX-F1; EASIX-F2; and other variables of interest with maximum grade of CRS, with a plan to perform a multivariate analysis with any significant variables (p150 (Table 1). The single patient with HGT and D0 CRP <100 interestingly was a non-responder. For the full 86-patient cohort, D0 CRP ≥150 was the best cut-off, predicting a 90% incidence of HGT vs 12% if CRP <150 (OR 42, p<0.001). Image:Summary/Conclusion: On retrospective analysis of 67 axi-cel patients, D0 CRP was more strongly associated with CRS severity than more complex prognostic scores. D0 CRP level, especially if ≥150, showed strong association with high grade CAR-T toxicity and remained predictive in a 19-patient validation cohort. This has potential implications for management of axi-cel patients.
Boyle et al. (Wed,) studied this question.