PMID- 33781520 OWN - NLM STAT- MEDLINE DCOM- 20210702 LR - 20210702 IS - 2666-6367 (Electronic) IS - 2666-6367 (Linking) VI - 27 IP - 3 DP - 2021 Mar TI - Incidence and Management of Effusions Before and After CD19-Directed Chimeric Antigen Receptor (CAR) T Cell Therapy in Large B Cell Lymphoma. PG - 242.e1-242.e6 LID - S2666-6367(20)30099-3 [pii] LID - 10.1016/j.jtct.2020.12.025 [doi] AB - In patients with lymphoma, third-space fluid accumulations may develop or worsen during cytokine release syndrome (CRS) associated with chimeric antigen receptor (CAR) T cell therapy. Pre-existing symptomatic pleural effusions were excluded by the ZUMA-1 trial of axicabtagene ciloleucel for large B cell lymphoma (LBCL) and variants. The incidence and management of effusions during CAR T cell therapy for LBCL are unknown. We performed a single-center retrospective study evaluating 148 patients receiving CD19-directed CAR T cell therapy for LBCL between May 2015 and September 2019. We retrospectively identified patients who had radiographic pleural, pericardial, or peritoneal effusions that were present prior to the time of CAR T infusion (pre-CAR T) or that newly developed during the first 30 days after CAR T-cell infusion (post-CAR T). Of 148 patients, 19 patients had a pre-CAR T effusion, 17 patients without pre-existing effusion developed a new infusion after CAR T, and 112 patients had no effusions. Comparing pre-CAR T effusions to new effusions post-CAR T, pre-CAR T effusions were more often malignant (84% versus 12%), persistent beyond 30 days (95% versus 18%), and required interventional drainage after CAR T infusion (79% versus 0%). Compared to patients with no effusion, patients with pre-CAR T therapy effusions had a higher frequency of high-risk baseline characteristics, such as bulky disease and high International Prognostic Index. Similarly, patients with pre-CAR T therapy effusions had a higher rate of toxicity with grade 3 or higher CRS occurring in 32% of patients. On multivariate analysis adjusting for age, Eastern Cooperative Oncology Group status, bulky disease, albumin, and lactate dehydrogenase, a pre-CAR T therapy effusion was associated with reduced overall survival (hazard ratio, 2.34; 95% confidence interval, 1.09 to 5.03; P = .03). Moreover, there was higher non-relapse mortality (11% versus 1%; P = .005). Post-CAR T effusions were not associated with significant difference in survival. Effusions commonly complicate CAR T cell therapy for lymphoma. Malignant effusions that occur prior to CAR T therapy are frequently persistent and require therapeutic intervention, and patients have a higher rate of toxicity and death. Effusions that newly occur after CAR T therapy can generally be managed medically and tend not to persist. CI - Copyright (c) 2020 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved. FAU - Mirza, Abu-Sayeef AU - Mirza AS AD - Department of Internal Medicine, University of South Florida, Tampa, Florida. FAU - Kumar, Ambuj AU - Kumar A AD - University of South Florida Morsani College of Medicine, Tampa, Florida. FAU - Hashmi, Hamza AU - Hashmi H AD - Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida. FAU - Garcia, Franco AU - Garcia F AD - Department of Internal Medicine, University of South Florida, Tampa, Florida. FAU - Logothetis, Constantine N AU - Logothetis CN AD - Department of Internal Medicine, University of South Florida, Tampa, Florida. FAU - Darwin, Alicia AU - Darwin A AD - University of South Florida Morsani College of Medicine, Tampa, Florida. FAU - Faramand, Rawan AU - Faramand R AD - Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida; Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida. FAU - Reid, Kayla AU - Reid K AD - Clinical Science Division, Moffitt Cancer Center, Tampa, Florida. FAU - Bachmeier, Christina AU - Bachmeier C AD - Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida. FAU - Chavez, Julio C AU - Chavez JC AD - Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida; Department of Malignant Hematology, Moffitt Cancer Center, Tampa, Florida. FAU - Shah, Bijal AU - Shah B AD - Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida; Department of Malignant Hematology, Moffitt Cancer Center, Tampa, Florida. FAU - Pinilla-Ibarz, Javier AU - Pinilla-Ibarz J AD - Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida; Department of Malignant Hematology, Moffitt Cancer Center, Tampa, Florida. FAU - Khimani, Farhad AU - Khimani F AD - Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida; Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida. FAU - Lazaryan, Aleksandr AU - Lazaryan A AD - Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida; Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida. FAU - Liu, Hien AU - Liu H AD - Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida; Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida. FAU - Davila, Marco L AU - Davila ML AD - Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida; Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida. FAU - Nishihori, Taiga AU - Nishihori T AD - Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida; Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida. FAU - Locke, Frederick L AU - Locke FL AD - Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida; Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida. Electronic address: Frederick.Locke@moffitt.org. FAU - Jain, Michael D AU - Jain MD AD - Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida; Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida. Electronic address: Michael.Jain@moffitt.org. LA - eng PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20201227 PL - United States TA - Transplant Cell Ther JT - Transplantation and cellular therapy JID - 101774629 RN - 0 (Receptors, Chimeric Antigen) SB - IM MH - Cell- and Tissue-Based Therapy MH - Humans MH - Immunotherapy, Adoptive MH - Incidence MH - *Lymphoma, Large B-Cell, Diffuse/therapy MH - *Receptors, Chimeric Antigen MH - Retrospective Studies OTO - NOTNLM OT - CAR T cell therapy OT - CRES OT - CRS OT - Effusions OT - Lymphoma EDAT- 2021/03/31 06:00 MHDA- 2021/07/03 06:00 CRDT- 2021/03/30 06:10 PHST- 2020/11/01 00:00 [received] PHST- 2020/12/20 00:00 [revised] PHST- 2020/12/24 00:00 [accepted] PHST- 2021/03/30 06:10 [entrez] PHST- 2021/03/31 06:00 [pubmed] PHST- 2021/07/03 06:00 [medline] AID - S2666-6367(20)30099-3 [pii] AID - 10.1016/j.jtct.2020.12.025 [doi] PST - ppublish SO - Transplant Cell Ther. 2021 Mar;27(3):242.e1-242.e6. doi: 10.1016/j.jtct.2020.12.025. Epub 2020 Dec 27.