Dynamic risk stratification using early CAR-T expansion in R/R LBCL treated with axicabtagene ciloleucel
In brief
Day 7 CAR-T expansion at least 48 cells/µL halves risk of progression in relapsed LBCL
In 176 patients receiving axicabtagene ciloleucel, those with a day-7 CAR-T count of at least 48 cells per microliter experienced about a 50% lower chance of disease progression, even after adjusting for LDH and bridging response. Higher early expansion also predicted more severe cytokine release syndrome and neurotoxicity, but needed steroids did not worsen outcomes, suggesting early cell counts can guide monitoring intensity.
- Journal
- British journal of haematology (Q1)
- Published
- 7 September 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Brydon Panozzo, Samuel Robinson, Adrian G Minson, Jian Li, Kylie Baldwin, Hamish W Scott, et al.
- PMID
- 42704001
- DOI
- 10.1111/bjh.70825
Why clinicians should know about it
- Picked for Hematology (paper of the day, 9 September 2026): Dynamic risk stratification using early CAR-T expansion in LBCL
Abstract
The clinical utility of routine monitoring of chimeric antigen receptor (CAR) T-cell expansion post-infusion remains controversial. We conducted a retrospective analysis of a prospectively collected cohort of 176 patients with relapsed/refractory large B-cell lymphoma (LBCL) treated with axicabtagene ciloleucel (axi-cel). CAR T-cell expansion was measured by flow cytometry at days 7, 14 and 28 following infusion with real-time reporting to the clinical service in 111 patients. We examined the association between CAR T-cell expansion, efficacy (progression-free survival [PFS]), toxicity (cytokine release syndrome [CRS] and immune effector cell-associated neurotoxicity syndrome [ICANS]) and toxicity management, accounting for baseline risk factors. A multivariable model combining day 7 expansion with pre-lymphodepletion lactate dehydrogenase (LDH) and bridging response demonstrated that robust day 7 expansion (≥48 cells/μL) was independently associated with improved PFS (hazard ratio [HR], 0.43; 95% confidence interval [CI] 0.22-0.83; p = 0.01). Higher day 7 expansion was associated with increased CRS severity and ICANS incidence. Higher corticosteroid exposure reflected this toxicity burden but was not associated with inferior PFS. Thus, incorporating quantitative CAR-T enumeration into clinical practice may dynamically refine risk stratification post-infusion and guide individualised management, such as the frequency of monitoring for progressive disease in the era of effective subsequent therapies.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.