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REVIEW PAPER
The role of anakinra in the treatment of CAR-T-induced cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) – a narrative review
1
Postgraduate Internship Programme, Clinical Hospital, Poznań, Poland
2
Department of Skin Diseases and Venerology, Pomeranian Medical University, Szczecin, Poland
3
Postgraduate Internship Programme, Dr. Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
4
Faculty of Medicine, University of Medical Sciences, Poznań, Poland
Corresponding author
KEYWORDS
CAR-TAnakinraInterleukin-1 receptor antagonistCytokine release syndrome (CRS)Immune effector cell-associated neurotoxicity syndrome (ICANS)
TOPICS
ABSTRACT
Introduction and objective:
Chimeric antigen receptor T-cell (CAR-T) therapy is a transformative immunotherapy that has achieved promising clinical efficacy in the treatment of haematologic malignancies. However, its modality is frequently complicated by cytokine release syndrome (CRS), and immune effector cell-associated neurotoxicity syndrome (ICANS). Anakinra is an immunosuppressant and antagonist of human interleukin-1 receptors, widely used to treat these syndromes. The aim of the study is to evaluate the efficacy and safety of anakinra and compare dosing regimens in patients with CRS and ICANS caused by CAR-T administration.
Review methods:
A narrative review of the literature was conducted using the PubMed/MEDLINE and Google Scholar databases, covering the period from 2020 – May 2026. English-language systematic reviews, randomized trials, retrospective studies, and case reports on anakinra usage in CRS and ICANS were included.
Brief description of the state of knowledge:
Anakinra provides an effective targeted strategy for managing ICANS that mitigates neuroinflammation without the broad immunosuppression associated with corticosteroids. However, increasing the dosage of corticosteroids remains the cornerstone of treating refractory ICANS. A prophylactic anakinra strategy has been demonstrated to have limited efficacy against high-grade neurotoxicity and an increased probability for severe infections.
Summary:
Anakinra has been proven most effective as a strategic second-line intervention for steroid-refractory ICANS cases. More studies are needed to determine the optimal prevention strategy for CRS and ICANS in patients receiving CAR-T therapy, as well as the optimal integration of anakinra into these protocols.
Chimeric antigen receptor T-cell (CAR-T) therapy is a transformative immunotherapy that has achieved promising clinical efficacy in the treatment of haematologic malignancies. However, its modality is frequently complicated by cytokine release syndrome (CRS), and immune effector cell-associated neurotoxicity syndrome (ICANS). Anakinra is an immunosuppressant and antagonist of human interleukin-1 receptors, widely used to treat these syndromes. The aim of the study is to evaluate the efficacy and safety of anakinra and compare dosing regimens in patients with CRS and ICANS caused by CAR-T administration.
Review methods:
A narrative review of the literature was conducted using the PubMed/MEDLINE and Google Scholar databases, covering the period from 2020 – May 2026. English-language systematic reviews, randomized trials, retrospective studies, and case reports on anakinra usage in CRS and ICANS were included.
Brief description of the state of knowledge:
Anakinra provides an effective targeted strategy for managing ICANS that mitigates neuroinflammation without the broad immunosuppression associated with corticosteroids. However, increasing the dosage of corticosteroids remains the cornerstone of treating refractory ICANS. A prophylactic anakinra strategy has been demonstrated to have limited efficacy against high-grade neurotoxicity and an increased probability for severe infections.
Summary:
Anakinra has been proven most effective as a strategic second-line intervention for steroid-refractory ICANS cases. More studies are needed to determine the optimal prevention strategy for CRS and ICANS in patients receiving CAR-T therapy, as well as the optimal integration of anakinra into these protocols.
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| eISSN: | 1898-7516 |
| ISSN: | 1898-2395 |
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