Toxicity Profile of CAR T-Cell Therapy Appears Safe in Follicular and Marginal Zone Lymphomas

Caron Jacobson, MD, medical director of the Immune Effector Cell Therapy Program and physician at Dana-Farber Cancer Institute, and assistant professor of medicine at Harvard Medical School, discusses the safety findings from the phase 2 ZUMA-5 tidal evaluating a CD19-directed chimeric antigen receptor (CAR) T-cell therapy, axicabtagene ciloleucel (axi-cel; Yescarta), in patients with follicular lymphoma (FL) and marginal zone lymphoma (MZL).

The safety profile was a little better in the FL cohort, so much so that it potentially raises the question of whether axi-cel could be administered in the outpatient setting, Jacobson says. About 23% of patients in the FL cohort had no cytokine release syndrome (CRS), and among those that did have CRS, the median time to onset was 4 days as opposed to 2 days in large cell lymphoma. Only 7% if patients in the FL cohort had high-grade CRS.

In terms of neurological toxicity in the FL cohort, 15% had high-grade events, which remains in line with what is expected with axi-cel in large cell lymphoma, Jacobson says.

The MZL cohort had a slightly higher incidence of CRS and higher-grade neurological toxicity that was more aligned with data for diffuse large B-cell lymphoma, according to Jacobson. The median time to onset of CRS in this cohort was about 4 days as well, so it was the same degree of toxicity with the FL cohort but later than we are used to seeing in large cell lymphoma.

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