A phase 1 study of prophylactic anakinra to mitigate ICANS in patients with large B-cell lymphoma

Axicabtagene ciloleucel (axi-cel), an autologous anti-CD19 chimeric antigen receptor (CAR) T-cell product approved for patients with relapsed and/or refractory large B-cell lymphoma (LBCL), results in cytokine release syndrome (CRS) in 90% to 95% of patients and immune effector cell – associated neurotoxicity syndrome (ICANS) in 60% to 64% of patients. 1,2 Corticosteroids represent the only current treatment option for ICANS, and although their negative impact on outcomes remains controversial, high doses and prolonged duration of corticosteroid treatment may hamper CAR T-cell function, in addition to potentially increasing the risk of infectious complications. 3-5 We have previously shown that the presence of myeloid-like ICANS-associated cells (IACs) expressing high levels of interlukin-1 β (IL-1 β ) within axi-cel infusion products is associated with the development of high-grade