Tocilizumab Prophylaxis Following Idecabtagene Vicleucel in the Outpatient Setting in Patients with Relapsed or Refractory Multiple Myeloma

Document Type

Conference Proceeding

Publication Date

2-1-2026

Publication Title

Transplant Cell Ther

Keywords

idecabtagene vicleucel, interleukin 6, tocilizumab, adult, aged, chimeric antigen receptor T-cell immunotherapy, conference abstract, controlled study, cytokine release syndrome, drug therapy, female, hospitalization, human, incidence, major clinical study, male, multiple myeloma, neurotoxicity, prevention, prophylaxis, retrospective study, side effect, therapy, treatment duration

Abstract

Introduction: Idecabtagene vicleucel (Ide-cel) is an autologous anti-BCMA chimeric antigen receptor (CAR) T cell therapy approved after three lines of therapy in patients with relapsed/refractory multiple myeloma. Historically the majority of patients treated with Ide-cel will experience cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS) based on the KarMMa-3 trial median onset for CRS is 1 day and it occurred in 88% of patients with 4% experiencing grade 3 or higher. ICANS occurred in 40% of patients with 4% developing grade 3 or higher. Objectives: Based on this we retrospectively studied 7 patients in the outpatient setting if 1 dose of tocilizumab (8mg/kg) an Il-6 receptor-blocking agent given prophylactically within 2 hours after the infusion would reduce CAR-T toxicities. Methods: We conducted a retrospect review of adult patients with RRMM who received Ide-cel between July 2024 until September 2025 at Henry Ford Cancer Institute in the outpatient setting. To determine setting if 1 dose of tocilizumab (8mg/kg) an Il-6 receptor-blocking agent given prophylactically within 2 hours after the infusion would reduce CAR-T toxicities including CRS and ICANS. Results: A total of 11 patients with RRMM were included in the analysis. The median age was 67.5 (range 51-79) and 71% were female. Patients received a median of 4 prior lines of therapy. Higher disease burden did not impact the ability to treat the patients with prophylactic tocilizumab. Of the 7 patients treated 4 of the 7 (57%) developed grade 1 CRS within 24 hours requiring inpatient admission while 3 of the 7 (42%) treated patients did not develop any grade CRS and were able to remain in the outpatient setting. None of the 7 patients treated developed ICANS of any grade. Conclusion: In this single center retrospective study in patients with RRMM who received prophylactic tocilizumab (8mg/kg) within 2 hours of the infusion with Ide-cel significantly impacted the incidence and duration of treatment related toxicities. The use of prophylactic tocilizumab was associate with a lower incidence of both CRS 57% and ICANS 0% and the requirement for hospitalization. The incidence of both CRS and ICANS were both significantly reduced compared to historical data based on the KarMMa-3 study that reported an incidence of CRS was 88% and the incidence of ICANS was 40%. Also, tocilizumab prophylaxis was not associated with response rates or survival in patients that were treated with Ide-cel.

Volume

32

Issue

2

First Page

S201

Last Page

S202

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