Utilizing dexamethasone earlier than remedy was related to much less extreme immune effector cell-associated neurotoxicity syndrome (ICANS) however didn’t change how usually neurotoxicity or cytokine launch syndrome (CRS) occurred in individuals with relapsed or refractory giant B-cell lymphoma (LBCL) handled with Yescarta (axicabtagene ciloleucel; axi-cel), based on information from a single-institution retrospective overview offered on the 2025 American Society of Hematology Annual Assembly and Exposition.
Additional, peak absolute lymphocyte counts was increased in sufferers who acquired dexamethasone prophylaxis, and survival outcomes have been comparable between teams.
“Our examine reveals that, total, there have been no vital variations in charges of CRS and ICANS on the whole with dexamethasone prophylaxis,” mentioned Dr. Christina Darwish, a second-year fellow at Fox Chase Most cancers Heart at Temple College Hospital in Philadelphia, Pennsylvania, who offered the info. “Nevertheless, the charges of grade 3 or 4 ICANS have been decrease amongst those that did obtain dexamethasone prophylaxis.”
How Dexamethasone Alters the Severity and Sample of CRS and ICANS
No grade 3 or 4 ICANS occasions occurred within the dexamethasone group versus 25% within the no-dexamethasone group. The whole price of ICANS occasions was decrease within the group that acquired dexamethasone versus the group that didn’t.
No grade 2 ICANS occasions occurred in both group, and 21% versus 13% within the dexamethasone and no-dexamethasone teams, respectively, had grade 1 immune effector cell-associated neurotoxicity syndrome.
Charges of grade 1, grade 2, and grade 3 CRS have been 46%, 25%, and 0% within the dexamethasone group versus 38%, 31%, and 0% within the no-dexamethasone group, respectively. Complete CRS charges have been 71% and 69% within the teams, respectively.
Affect of Dexamethasone on Therapy Response and Lengthy-Time period Outcomes
Extended follow-up demonstrated an total response price of 89% versus 75% in dexamethasone and no-dexamethasone teams, respectively. Full response charges have been 79% and 69%, respectively. Two-year total survival was 72.2% versus 67.7%, and progression-free survival was 49.9% versus 60.6%, respectively.
Peak median absolute lymphocyte depend was 750 cells per microliter versus 500 cells per microliter in prophylaxis and no-prophylaxis teams, respectively. Median time to peak absolute lymphocyte depend was shorter within the dexamethasone group at 9.5 days versus 17 days within the no-dexamethasone group.
Median follow-up for the evaluation was 21.4 months within the dexamethasone group and 32.5 months within the no-dexamethasone group.
How the Research Was Structured and Who Was Handled
Forty-four sufferers have been handled with Yescarta, and 28 acquired dexamethasone prophylaxis, though 16 didn’t. Those that acquired dexamethasone prophylaxis acquired the steroid at 10 mg orally on days 0, 1, and a pair of after infusion.
Most sufferers within the dexamethasone group had diffuse LBCL (68%), adopted by follicular lymphoma (29%), and first mediastinal LBCL (4%). No sufferers within the dexamethasone group had high-grade B-cell lymphoma or marginal zone lymphoma.
Within the no-dexamethasone group, 63% had diffuse giant B-cell lymphoma, 19% had follicular lymphoma, 13% had high-grade B-cell lymphoma, and 6% had marginal zone lymphoma. No sufferers on this group had main mediastinal giant B-cell lymphoma.
Sufferers in dexamethasone and no-dexamethasone teams had a median age of 63 years and 62 years, respectively; 92% versus 73% had Lugano stage 3 to 4 illness; 71% versus 75% had high-grade lymphoma; 18% versus 13% had cumbersome illness; and 75% of every group acquired bridging remedy. With regard to lymphodepleting remedy, most sufferers within the dexamethasone group acquired bendamustine and most sufferers within the no-dexamethasone group acquired fludarabine and cyclophosphamide.
Most sufferers within the dexamethasone group and no dexamethasone group had an Japanese Cooperative Oncology Group efficiency standing of 0 to 1; 4% versus 6%, respectively, had a rating of two; and 4% versus 0% had a rating of three. Fifty-seven p.c of the dexamethasone group was male versus 31% within the no-dexamethasone group.
Context for Understanding Yescarta and Early Questions About Steroid Use
Yescarta, a cluster of differentiation 19-targeting chimeric antigen receptor T-cell remedy, is accredited for the remedy of sufferers with LBCL relapsed or refractory to chemoimmunotherapy inside 12 months of frontline remedy, in addition to for the remedy of sufferers with relapsed or refractory LBCL following 2 or extra traces of systemic remedy together with diffuse LBCL not in any other case specified, main mediastinal giant B-cell lymphoma, high-grade B-cell lymphoma, and diffuse LBCL occurring because of follicular lymphoma.
The agent additionally acquired accelerated approval for the remedy of sufferers with relapsed or refractory follicular lymphoma following 2 or extra traces of prior systemic remedy.
In line with Darwish, earlier issues have existed concerning the usage of steroids in chimeric antigen receptor T-cell therapies attributable to fear that steroids could restrict chimeric antigen receptor T-cell growth and efficacy following infusion. Nevertheless, outcomes from a security cohort of the ZUMA-1 trial revealed that dexamethasone prophylaxis enhanced security of Yescarta with out compromising efficacy.
References
- “Lengthy-term outcomes of dexamethasone prophylaxis after axicabtagene ciloleucel for non-Hodgkin lymphoma: a single-center retrospective examine,” by Dr. Christina Darwish. Blood.
- “Yescarta Prescribing info,” by Gilead Sciences. December 9, 2025. https://www.gilead.com/-/media/information/pdfs/medicines/oncology/yescarta/yescarta-pi.pdf
- “Prophylactic corticosteroid use with axicabtagene ciloleucel (axi-cel) in sufferers (pts) with relapsed/refractory giant B-cell lymphoma (R/R LBCL): 2-year follow-up of ZUMA-1 cohort 6,” by Dr. Olalekan Oluwole. Blood.
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