Phase 2 trial of anakinra for ICANS prophylaxis in CD19 CAR T-cell therapy for relapsed or refractory lymphoma

In preclinical models, the IL-1 receptor antagonist anakinra reduced immune effector cell-associated neurotoxicity syndrome (ICANS) without compromising anti-CD19 chimeric antigen receptor (CAR T-cell efficacy. A phase 2 trial at Memorial Sloan Kettering Cancer Center (New York, NY) evaluated anakinra for prophylaxis of ICANS in patients receiving CD19-directed CAR T-cell therapy for recurrent or refractory LBCL or MCL. All-grade ICANS occurred in 19% of patients, and grade 3 ICANS in 9.7%. There were no grade 4 or 5 ICANS events. The overall disease response rate was 77% with 65% complete response. The authors conclude that these initial results show that prophylactic anakinra resulted in a low incidence of ICANS in patients receiving anti-CD19 CAR T-cell therapy for R/R lymphoma.