Vanderbilt-Ingram Cancer Center
The goal of this clinical trial is to reduce the duration of ICANS and incidence of G3 or great ICANS in participants who receive axi-cel. The main questions the study aims to answer are: Efficacy of IT therapy to reduce high-grade ICANS in participants who receive axi-cel in NHL compared to historical experience. This phase II trial tests how well giving intrathecal (IT) cytarabine and hydrocortisone works for the early treatment of immune effector cell associated neurotoxicity syndrome (ICANS) in patients undergoing chimeric antigen response (CAR) t cell therapy for the treatment of non Hodgkin Lymphoma that has come back after a period of improvement (recurrent) or that has not responded o previous treatment (refractory). CAR T-cell therapy can sometimes cause an overactive immune response and inflammation. This can cause a side effect called ICANS that affects the rain and may lead to symptoms such as confusion, difficulty speaking, or other neurological problems. Giving cytarabine and hydrocortisone directly into the fluid around the brain and spinal cord (called intrathecal treatment) may help lower the body's immune response and reduce inflammation. Giving IT cytarabine and hydrocortisone may be effective for early treatment of CANS in patients undergoing CAR T cell therapy for relapsed or refractory non Hodgkin Lymphoma.
PRIMARY OBJECTIVE: I. Efficacy of IT therapy to reduce high-grade ICANS in participants who receive axi-cel in NHL compared to historical experience. SECONDARY OBJECTIVE: I. Impact of IT therapy on CAR T toxicities. II. Adverse events from IT therapy. III. Feasibility of IT therapy. IV. Impact of IT therapy on standard of care (SOC) manage (CRS) and ICANS. V. Impact of IT therapy on disease outcomes. VI. Impact of IT therapy on participants quality of life (QoL) OUTLINE: Patients receive standard of care cyclophosphamide based chemotherapy on day -5 to -3 and receive CAR T on day 0. Patie…
Inclusion Criteria: 1. Age ≥ 18 years 2. Histologically confirmed non-Hodgkin Lymphoma, including the following types defined by the World Health Organization (2017) or International Consensus Classification (2022): * Diffuse large B-cell lymphoma (DLBCL) * Primary mediastinal large B-cell lymphoma (PMBCL) * Transformed follicular lymphoma (tFL) * Transformed marginal zone lymphoma (tMZL) * High-grade B-cell lymphoma (HGBL) with MYC and BCL2 and/or BCL6 rearrangements * Follicular lymphoma * Mantle cell lymphoma * Marginal zone lymphoma 3. Meets institutional eligibil…
100 mg IT with onset of grade 1/2 ICANS
100 mg IT with onset of grade 1/2 ICANS
IV 10mg
1g daily until adverse events resolves
Given as standard of care
Given as standard of care
Given as standard of care