Dr Oluwole on CRS and Neurotoxicity Beyond 2 Weeks After Axi-Cel Infusion in R/R LBCL

"This opens the door for some select patients [to undergo less monitoring for CRS and neurologic toxicities]. Perhaps it might be a reasonable option not to monitor them at the academic center; maybe they can go back home early. Maybe we can use more telemedicine and other means to allow them to get some semblance of a return to normal.”

Olalekan Oluwole, MD, MPH, associate professor of medicine, Division of Hematology Oncology, Vanderbilt University Medical Center, discusses findings from a study on the incidence and resolution of cytokine release syndrome (CRS) and neurological toxicities beyond 2 weeks following the infusion of axicabtagene ciloleucel (axi-cel; Yescarta) in patients with relapsed/refractory large B-cell lymphoma (LBCL). These data were presented at the 2025 Transplantation & Cellular Therapy Meetings.

The analysis evaluated the trajectory of CRS and neurological adverse effects (AEs), which are known toxicities associated with CAR T-cell therapy and require management/mitigation strategies, including staying in proximity of the infusion center for 4 weeks following CAR T-cell therapy infusion.

Findings from the study showed that more than half of patients experienced CRS or neurotoxicities; however, most of these events occurred and resolved within the first 2 weeks post-infusion, Oluwole says. Notably, beyond two weeks post-infusion, Oluwole notes no new instances of CRS or neurological toxicities were reported, and although some patients were still recovering from an AE occurring in the first 2 weeks, most patients experienced full resolution by 2 weeks.

These findings suggest that prolonged hospitalization or extended monitoring at an academic center may not be necessary for all patients with LBCL receiving axi-cel Oluwole notes. Given the requirement for patients to remain within close proximity to their treating centers post-infusion with a caretaker, these data highlight a potential opportunity to modify current post–CAR T-cell monitoring protocols, he explains. Many patients, including those who are employed or reside in rural areas, are required to relocate temporarily for treatment, posing logistical and financial challenges, he continues With the observed low incidence of new-onset toxicities beyond 2 weeks, there is a rationale for exploring alternative monitoring strategies, such as telemedicine, to facilitate earlier patient discharge and allow select patients to return home sooner, Oluwole concludes.