Myeloma CAR-T CRS Management With IL-1R Antagonist Anakinra

Anti-B-cell maturation antigen (BCMA) chimeric antigen receptor T cell (CAR-T) cell therapy has demonstrated promising clinical efficacy in myeloma but is accompanied by cytokine release syndrome (CRS), wherein clinical management is challenging owing to lack of therapeutic options. Interleukin (IL)-6 inhibition with the monoclonal antibody tocilizumab, administered alone or with steroids is the most common approach for treating CRS currently. Anti-IL-1 therapy has a strong preclinical scientific rationale for CRS mitigation after CAR-T cell therapy and may complement current approaches. We contrast clinical features and laboratory parameters from 2 patients having CRS post anti-BCMA CAR-T infusion for myeloma, 1 treated with tocilizumab alone and the other illustrating the use of adjunctive anti-IL-1R therapy with anakinra. We therefore see merit in the use of IL-1 inhibition as a valuable adjunct in the management of CRS following CAR-T therapy in myeloma.