{"doi":"10.1002/hem3.70248","title":"Patterns and safety of glucocorticosteroid use following CD19 CAR‐T therapy for large B‐cell lymphoma","abstract":"Corticosteroids are commonly used to manage cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) following chimeric antigen receptor (CAR) T-cell therapy, and yet, their dose-specific impact on outcomes remains uncertain. We retrospectively evaluated 276 adults with large B-cell lymphoma (LBCL) treated with CD19-directed CAR-T therapy (axi-cel, tisa-cel, or liso-cel) between 2016 and 2023 at a single institution. Cumulative corticosteroid dose was defined as the total dose administered within 21 days of infusion. Corticosteroids were administered to 105 patients (38%), initiated at a median of 5 days post-infusion (interquartile range [IQR] 3-7) for CRS (38%), ICANS (15%), or both (47%). Use was more frequent with axi-cel (P < 0.001), although the cumulative dose and duration were similar across products. To assess the impact of corticosteroid exposure, we carried out a 21-day landmark analysis. Corticosteroid exposure, modeled as a time-dependent covariate, was not significantly associated with infection risk, non-relapse mortality, or inferior overall survival (OS) or progression-free survival (PFS). However, in a landmark analysis, patients receiving above-median cumulative corticosteroid doses had a significantly higher risk of infection compared to those receiving below-median corticosteroid doses or no corticosteroids (P = 0.042). In a landmark multivariable analysis, corticosteroid cumulative dose was associated with increased late hematologic toxicity (adjusted hazard ratio [HR] 1.02, 95% CI 1.02-1.03). Finally, in a sensitivity analysis excluding patients with Grade ≥4 CRS/ICANS, corticosteroid cumulative dose remained unassociated with OS or relapse, but was linked to shorter PFS (adjusted HR 1.04, 95% CI 1.01-1.06). These findings support the safe yet judicious use of corticosteroids to manage CAR-T toxicities in LBCL.","journal":"HemaSphere","year":2025,"id":583323,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9556,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1012588,"name":"David Nemirovsky","orcid":"0009-0007-6971-1408","position":1,"is_corresponding":false},{"id":90690,"name":"Sean M. Devlin","orcid":"0000-0002-6801-720X","position":2,"is_corresponding":false},{"id":282396,"name":"Alexander P. Boardman","orcid":"0000-0001-7169-9275","position":3,"is_corresponding":false},{"id":1229424,"name":"Giulio Cassanello","orcid":"0000-0002-2192-9930","position":4,"is_corresponding":false},{"id":670901,"name":"Magdalena Corona","orcid":"0000-0002-6553-0171","position":5,"is_corresponding":false},{"id":510045,"name":"Danny Luan","orcid":"0000-0002-1167-1307","position":6,"is_corresponding":false},{"id":237600,"name":"Parastoo B. Dahi","orcid":"0000-0002-0794-3226","position":7,"is_corresponding":false},{"id":342145,"name":"Alejandro Luna","orcid":"0000-0003-2201-3091","position":8,"is_corresponding":false},{"id":246204,"name":"Lorenzo Falchi","orcid":"0000-0003-1531-3838","position":9,"is_corresponding":false},{"id":1209601,"name":"Ivan Landego","orcid":"0009-0005-3628-4695","position":10,"is_corresponding":false},{"id":108863,"name":"Richard J. Lin","orcid":"0000-0002-0834-7880","position":11,"is_corresponding":false},{"id":721706,"name":"Jennifer Kimberly Lue","orcid":"0000-0001-8153-1820","position":12,"is_corresponding":false},{"id":248512,"name":"Lia Palomba","orcid":null,"position":13,"is_corresponding":false},{"id":292601,"name":"Jae H. Park","orcid":"0000-0002-2903-5130","position":14,"is_corresponding":false},{"id":1169070,"name":"Sandeep Raj","orcid":"0000-0003-4629-0528","position":15,"is_corresponding":false},{"id":1031829,"name":"Kai Rejeski","orcid":"0000-0003-3905-0251","position":16,"is_corresponding":false},{"id":556957,"name":"Alfredo Rivas‐Delgado","orcid":"0000-0003-0385-3415","position":17,"is_corresponding":false},{"id":108867,"name":"Michael Scordo","orcid":"0000-0002-9484-0240","position":18,"is_corresponding":false},{"id":108862,"name":"Ana Alarcón Tomás","orcid":"0000-0002-6290-1061","position":19,"is_corresponding":false},{"id":108865,"name":"Gunjan L. Shah","orcid":"0000-0002-9977-0456","position":20,"is_corresponding":false},{"id":108873,"name":"Miguel‐Angel Perales","orcid":"0000-0002-5910-4571","position":21,"is_corresponding":false},{"id":404955,"name":"Gilles Salles","orcid":"0000-0002-9541-8666","position":22,"is_corresponding":false},{"id":55979,"name":"Roni Shouval","orcid":"0000-0001-9827-8032","position":23,"is_corresponding":false},{"id":1209600,"name":"Efrat Luttwak","orcid":"0000-0003-0212-2135","position":0,"is_corresponding":true}],"reference_count":38,"raw_metadata":null,"created_at":"2026-07-19T02:59:03.725721Z","pmid":"41321357","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}