左乙拉西坦常规预防在大 B 细胞淋巴瘤 CD19 CAR-T 治疗中无获益：一项多中心倾向性匹配研究

This study aims to evaluate the impact of levetiracetam (LVT) prophylaxis on the incidence and severity of immune effector cell-associated neurotoxicity syndrome (ICANS) in patients undergoing anti-CD19 chimeric antigen receptor T-cell (CAR-T) therapy for LBCL (large B-cell lymphoma). A propensity score-matched cohort of 254 patients was analyzed, comparing those receiving LVT prophylaxis (LTV-yes) with those not receiving it (LTV-no), in a 1:1 ratio.

The results showed no significant difference in the occurrence of ICANS of any grade between the 2 groups (32. 3% in LVT-no vs 37. 1% in LVT-yes; P = . 29), or in severe ICANS (grades 2-4, 15. 1% vs 16. 1% [P = . 80]; grade 3-4, 7. 9% vs 9. 7% [P = . 71]). The use of LVT was associated with a higher incidence of early immune effector cell-associated hematotoxicity (ICAHT), with grade 2 to 4 ICAHT occurring in 37. 3% vs 63. 9% (P < . 001) of patients in the LVT-no and LVT-yes groups, respectively.

Overall survival and progression-free survival did not differ significantly between the 2 groups (P = . 337 and . 670). Nonrelapse mortality rates were comparable (P = . 77).

These findings suggest that routine use of LVT as prophylaxis for ICANS in CAR-T therapy is not effective, and further research is needed to refine its role in selected populations or after ICANS treatment.