Hyperinflammatory Syndrome Resembling Haemophagocytic Lymphohistiocytosis Following Axicabtagene Ciloleucel and Brexucabtagene Autoleucel

Overview

Journal Br J Haematol

Specialty Hematology

Date 2022 Sep 16

PMID 36111395

Authors

Timothy J Porter

Ana Lazarevic

Jamie E Ziggas

Ephraim Fuchs

Kiryoung Kim

Helen Byrnes

Leo Luznik

Javier Bolanos-Meade

Syed Abbas Ali

Nirali N Shah

Nina Wagner-Johnston

Tania Jain

Affiliations

Soon will be listed here.

Abstract

Haemophagocytic lymphohistiocytosis-like toxicity following chimeric antigen receptor T cells (CAR-HLH) is being increasingly recognized, while published data are limited and criteria for recognition are elusive. We describe three patients who developed CAR-HLH after infusion of brexucabtagene autoleucel (n = 2) or axicabtagene ciloleucel (n = 1). All three patients presented following cytokine release syndrome, with fever, recurrent or worsening cytopenias, hyperferritinaemia, elevated soluble interleukin (IL)-2 receptor, hypofibrinogenaemia, hypertriglyceridaemia, elevated liver transaminases, and decreasing C-reactive protein and IL-6. Clinical improvement following treatment with anakinra (n = 2) and ruxolitinib (n = 1) was observed. Our report offers an opportunity for prompt recognition and initiation of potentially life-saving treatment for CAR-HLH.

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