Sex-based differences in complications in patients with diffuse large B cell lymphoma receiving axicabtagene ciloleucel therapy.

Abstract

e19057 Background: Improvement in quality of care and the introduction of novel therapies have led to a better prognosis of diffuse large B cell lymphoma (DLBCL) patients. One such novel therapy is Axicabtagene Ciloleucel, a form of CAR T-cell therapy that has shown promising results in DLBCL cases that are refractory after ≥2 lines of systemic therapy or that relapse within 12 months of first-line chemoimmunotherapy. This study evaluates how the in-hospital complications, which include adverse events and side effects, differed between males and females receiving such therapy. Methods: For this retrospective analysis, adults with DLBCL were identified from the National Inpatient Sample (2021-2022). We found hospitalized patients with a primary procedural code of Axicabtagene Ciloleucel therapy. Cases were divided into males and females, and their complications were compared via multivariable regression analyses. Results: Our study contained 1410 adults with DLBCL who were receiving Axicabtagene Ciloleucel therapy. There were 915 (64.9%) males and 495 (35.1%) females. The mean age of all patients was 60.71 years, with no statistical differences between males (mean age 60.39 years) and females(mean age 61.30 years)(p=0.180). Males reported higher odds of acute kidney injury (AKI) (aOR 1.784, 95% CI 1.186-2.682, p<0.01), fever (aOR 2.169, 95% CI 1.352-3.479, p<0.01), and cytokine release syndrome(CRS) (aOR 1.468, 95% CI 1.141-1.889, p<0.01). No differences were observed for events of cardiac arrhythmias (aOR 1.088, 95% CI 0.792-1.495, p=0.602), vomiting (aOR 0.762, 95% CI 0.508-1.144, p=0.190), nausea (aOR 1.079, 95% CI 0.696-1.674, p=0.734), sepsis (aOR 1.039, 95% CI 0.624-1.731, p=0.882), gastrointestinal bleeding (aOR 0.588, 95% CI 0.286-1.210,p=0.149), and acute respiratory failure (ARF) (aOR 0.670, 95% CI 0.443-1.013, p=0.057) between the males and females. Finally, we found that males were less likely to report pancytopenia than females (aOR 0.744, 95% CI 0.570-0.971, p=0.029). Conclusions: Our study reveals that while many of the side effects of Axicabtagene Ciloleucel therapy are comparable in males and females, there are significant differences. Males are more likely to experience fever, AKI, and CRS, while females are more likely to experience pancytopenia. These findings underscore the urgent need for further, more comprehensive studies to fully understand these differences and develop appropriate measures to reduce their complications. The potential impact of this research on patient care is significant, as it could lead to more tailored and effective treatments for DLBCL patients.