Little is known about the benefits and risks of
myeloid growth factor administration after
chimeric antigen receptor (CAR) T-cell therapy for
diffuse large B-cell lymphoma (DLBCL). We present a retrospective analysis among 22 relapsed/refractory DLBCL patients who received CAR T-cell therapy with
axicabtagene ciloleucel.
Filgrastim was administered by physician discretion to seven patients (31.8%), and the median duration of
neutropenia after lymphodepleting
therapy was significantly shorter for those patients who received
filgrastim (5 vs 15 days, P = .016). Five patients (22.7%) developed
infection in the 30 days post-CAR T-cell therapy with three patients being Grade 3 or higher. There was no difference in the incidence and severity of
infection based on
filgrastim use (P = .274, P = .138). Among the seven patients that received
filgrastim, six patients (85.7%) and four patients (57.1%) had evidence of
cytokine release syndrome (CRS) and
immune effector cell-associated neurotoxicity syndrome (ICANS), respectively. Among the 15 patients that did not receive
filgrastim, 8 patients (53.3%) and 7 patients (46.7%) had evidence of CRS and ICANS, respectively. There was no significant difference in the incidence of developing CRS or ICANS between the group of patients that received
filgrastim and those that did not (P = .193, P = .647). However, there was a significant increase in the severity of CRS for patients that received
filgrastim compared to those that did not (P = .042).
Filgrastim administration after CAR T-cell therapy may lead to an increase in severity of CRS without decreasing
infection rates.