What question did this study set out to answer?

This research examines how corticosteroid or tocilizumab use affects infection rates and outcomes in CAR T-cell therapy recipients.

May 30, 2026

Impact of corticosteroid and tocilizumab use on infection incidence and outcomes following CAR T-cell therapy with axicabtagene ciloleucel.

Q: What does this research mean for the field?

The use of corticosteroids and tocilizumab following CAR-T therapy is independently associated with increased risks of bacterial and fungal infections and higher infection-related mortality, without significantly impacting overall survival. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Points

This research examines how corticosteroid or tocilizumab use affects infection rates and outcomes in CAR T-cell therapy recipients.
Conducted a retrospective multicenter analysis using CIBMTR registry data restricted to axi-cel patients.
Compared infection incidence and survival outcomes between corticosteroid/tocilizumab users and non-users.
Applied Cox proportional hazards models to adjust for various baseline characteristics.
Corticosteroids/tocilizumab users had a higher overall infection incidence (HR 1.64; 95%CI 1.33–2.01; p<0.001).
Increased risk of bacterial (HR 1.92; 95%CI 1.46–2.52; p<0.001) and fungal infections (HR 2.47; 95%CI 1.25–4.88; p=0.009) was observed.
Higher infection-related mortality associated with their use (HR 4.24; 95%CI 1.29–13.94; p=0.018), but no significant difference in overall survival (HR 1.11; 95%CI 0.96–1.27; p=0.149).

Abstract

e19007 Background: Corticosteroids and tocilizumab are frequently used to manage cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS) following chimeric antigen receptor T-cell (CAR-T) therapy. However, their impact on post-infusion complications remains uncertain. We aimed to evaluate the association between corticosteroid or tocilizumab exposure and outcomes after CAR-T therapy. Methods: A retrospective multicenter analysis was performed using publicly available data from the Center for International Blood and Marrow Transplant Research (CIBMTR) registry (P-6093, Wudhikarn et al.), limited to patients who received axi-cel. Patients receiving corticosteroids and/or tocilizumab following CAR-T infusion were compared against those who did not. The primary outcome was 100-day infection incidence (overall, bacterial, viral, and fungal). Secondary outcomes included overall survival (OS), neutrophil engraftment, and infection-related mortality (IRM). Baseline characteristics were compared using chi-square and t-tests. Associations between corticosteroid/tocilizumab use and outcomes were assessed using Cox proportional hazards models adjusted for age, Karnofsky performance status (KPS), hematopoietic cell transplantation comorbidity index (HCT-CI), disease category, prior HCT, and transformed lymphoma status. Statistical significance was defined as p<0.05. Results: Among 2,749 CAR-T recipients, 1,873 (68.1%) received corticosteroids or tocilizumab. These patients were older (60.2±12.6 vs 58.1±13.4 years; p<0.001), had lower KPS (20.4% vs 15% with KPS < 80; p<0.001), and more frequently had transformed lymphoma (74% vs 64%; p<0.001) compared to those who did not. Corticosteroid/tocilizumab use was independently associated with higher 100-day overall infection incidence (HR 1.64; 95%CI 1.33–2.01; p<0.001), bacterial infections (HR 1.92; 95%CI 1.46–2.52; p<0.001), and fungal infections (HR 2.47; 95%CI 1.25–4.88; p=0.009). Viral infections were not significantly different between the two groups (HR 1.34; 95%CI 0.99–1.80; p=0.057). The use of corticosteroids/tocilizumab was also significantly associated with increased infection-related mortality (HR 4.24; 95%CI 1.29–13.94; p=0.018). However, there was no statistically significant difference in terms of overall survival (HR 1.11; 95%CI 0.96–1.27; p=0.149) or neutrophil engraftment (HR 0.92; 95%CI 0.84–1.01; p=0.089). Conclusions: Corticosteroid and tocilizumab use following CAR-T therapy is independently associated with an increased risk of bacterial and fungal infections and higher infection-related mortality, highlighting the importance of antimicrobial prophylaxis and infection surveillance.

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