{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T12:07:40Z","timestamp":1788782860496,"version":"build-2803163510"},"reference-count":39,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Br J Haematol"],"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    The clinical utility of routine monitoring of chimeric antigen receptor (CAR) T\u2010cell expansion post\u2010infusion remains controversial. We conducted a retrospective analysis of a prospectively collected cohort of 176 patients with relapsed\/refractory large B\u2010cell lymphoma (LBCL) treated with axicabtagene ciloleucel (axi\u2010cel). CAR T\u2010cell expansion was measured by flow cytometry at days 7, 14 and 28 following infusion with real\u2010time reporting to the clinical service in 111 patients. We examined the association between CAR T\u2010cell expansion, efficacy (progression\u2010free survival [PFS]), toxicity (cytokine release syndrome [CRS] and immune effector cell\u2010associated neurotoxicity syndrome [ICANS]) and toxicity management, accounting for baseline risk factors. A multivariable model combining day 7 expansion with pre\u2010lymphodepletion lactate dehydrogenase (LDH) and bridging response demonstrated that robust day 7 expansion (\u226548 cells\/\u03bcL) was independently associated with improved PFS (hazard ratio [HR], 0.43; 95% confidence interval [CI] 0.22\u20130.83;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.01). Higher day 7 expansion was associated with increased CRS severity and ICANS incidence. Higher corticosteroid exposure reflected this toxicity burden but was not associated with inferior PFS. Thus, incorporating quantitative CAR\u2010T enumeration into clinical practice may dynamically refine risk stratification post\u2010infusion and guide individualised management, such as the frequency of monitoring for progressive disease in the era of effective subsequent therapies.\n                  <\/jats:p>","DOI":"10.1111\/bjh.70825","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:10:02Z","timestamp":1788779402000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dynamic risk stratification using early\n                    <scp>CAR<\/scp>\n                    \u2010T expansion in R\/R\n                    <scp>LBCL<\/scp>\n                    treated with axicabtagene ciloleucel"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9642-1720","authenticated-orcid":false,"given":"Brydon","family":"Panozzo","sequence":"first","affiliation":[{"name":"Clinical Haematology Peter MacCallum Cancer Centre and Royal Melbourne Hospital  Melbourne Victoria Australia"},{"name":"Malignant Haematology, Transplantation and Cellular Therapy Service, Alfred Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Robinson","sequence":"additional","affiliation":[{"name":"Clinical Haematology Peter MacCallum Cancer Centre and Royal Melbourne Hospital  Melbourne Victoria Australia"},{"name":"Department of Pathology Peter MacCallum Cancer Centre  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7357-2024","authenticated-orcid":false,"given":"Adrian G.","family":"Minson","sequence":"additional","affiliation":[{"name":"Clinical Haematology Peter MacCallum Cancer Centre and Royal Melbourne Hospital  Melbourne Victoria Australia"},{"name":"The Sir Peter MacCallum Department of Oncology The University of Melbourne  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Li","sequence":"additional","affiliation":[{"name":"Malignant Haematology, Transplantation and Cellular Therapy Service, Alfred Hospital  Melbourne Victoria Australia"},{"name":"Australian Centre for Blood Diseases Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6437-1747","authenticated-orcid":false,"given":"Kylie","family":"Baldwin","sequence":"additional","affiliation":[{"name":"Department of Pathology Peter MacCallum Cancer Centre  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4953-7815","authenticated-orcid":false,"given":"Hamish W.","family":"Scott","sequence":"additional","affiliation":[{"name":"Clinical Haematology Peter MacCallum Cancer Centre and Royal Melbourne Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2097-6428","authenticated-orcid":false,"given":"Jane","family":"Oliaro","sequence":"additional","affiliation":[{"name":"The Sir Peter MacCallum Department of Oncology The University of Melbourne  Parkville Victoria Australia"},{"name":"Centre of Excellence in Cellular Immunotherapy Peter MacCallum Cancer Centre  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9424-4927","authenticated-orcid":false,"given":"Aaron J. N.","family":"Wong","sequence":"additional","affiliation":[{"name":"The Sir Peter MacCallum Department of Oncology The University of Melbourne  Parkville Victoria Australia"},{"name":"Department of Cancer Imaging Peter MacCallum Cancer Centre  Melbourne Victoria Australia"},{"name":"Department of Nuclear Medicine Peter MacCallum Cancer Centre  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2122-6496","authenticated-orcid":false,"given":"Samantha","family":"van der Linde","sequence":"additional","affiliation":[{"name":"Clinical Haematology Peter MacCallum Cancer Centre and Royal Melbourne Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4338-2246","authenticated-orcid":false,"given":"Nicole L.","family":"O'Leary","sequence":"additional","affiliation":[{"name":"Clinical Haematology Peter MacCallum Cancer Centre and Royal Melbourne Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip A.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Clinical Haematology Peter MacCallum Cancer Centre and Royal Melbourne Hospital  Melbourne Victoria Australia"},{"name":"The Sir Peter MacCallum Department of Oncology The University of Melbourne  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2188-6835","authenticated-orcid":false,"given":"John F.","family":"Seymour","sequence":"additional","affiliation":[{"name":"Clinical Haematology Peter MacCallum Cancer Centre and Royal Melbourne Hospital  Melbourne Victoria Australia"},{"name":"The Sir Peter MacCallum Department of Oncology The University of Melbourne  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3515-0215","authenticated-orcid":false,"given":"Mary Ann","family":"Anderson","sequence":"additional","affiliation":[{"name":"Clinical Haematology Peter MacCallum Cancer Centre and Royal Melbourne Hospital  Melbourne Victoria Australia"},{"name":"The Sir Peter MacCallum Department of Oncology The University of Melbourne  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9759-5017","authenticated-orcid":false,"given":"Constantine S.","family":"Tam","sequence":"additional","affiliation":[{"name":"Malignant Haematology, Transplantation and Cellular Therapy Service, Alfred Hospital  Melbourne Victoria Australia"},{"name":"Australian Centre for Blood Diseases Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4555-6582","authenticated-orcid":false,"given":"Simon J.","family":"Harrison","sequence":"additional","affiliation":[{"name":"Clinical Haematology Peter MacCallum Cancer Centre and Royal Melbourne Hospital  Melbourne Victoria Australia"},{"name":"The Sir Peter MacCallum Department of Oncology The University of Melbourne  Parkville Victoria Australia"},{"name":"Centre of Excellence in Cellular Immunotherapy Peter MacCallum Cancer Centre  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1492-5966","authenticated-orcid":false,"given":"Michael J.","family":"Dickinson","sequence":"additional","affiliation":[{"name":"Clinical Haematology Peter MacCallum Cancer Centre and Royal Melbourne Hospital  Melbourne Victoria Australia"},{"name":"The Sir Peter MacCallum Department of Oncology The University of Melbourne  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Immunol"},{"issue":"22","key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"6844","DOI":"10.1182\/bloodadvances.2023010364","article-title":"Early quantification of anti\u2010CD19 CAR T cells by flow cytometry predicts response in R\/R DLBCL","volume":"7","author":"Blumenberg V","year":"2023","journal-title":"Blood Adv"},{"issue":"3","key":"e_1_2_10_8_1","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.jtct.2025.01.001","article-title":"Reduced chimeric antigen receptor T cell expansion postinfusion is associated with poor survival in patients with large B cell lymphoma after two or more therapies","volume":"31","author":"Abadir E","year":"2025","journal-title":"Transplant Cell Ther"},{"key":"e_1_2_10_9_1","doi-asserted-by":"crossref","first-page":"3877","DOI":"10.1182\/blood-2021-152309","article-title":"Tisagenlecleucel and axicabtagene ciloleucel expansion kinetics and CAR T cell attributes in the infusion products are early predictors of clinical 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kinetics of circulating anti\u2010CD19 CAR\u2010T cells and their populations on the outcome of DLBCL patients","volume":"14","author":"Martin\u2010Martin L","year":"2024","journal-title":"Blood Cancer J"},{"key":"e_1_2_10_13_1","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.omtm.2019.12.018","article-title":"Digital PCR assays for precise quantification of CD19\u2010CAR\u2010T cells after treatment with axicabtagene ciloleucel","volume":"16","author":"Fehse B","year":"2020","journal-title":"Mol Ther Methods Clin Dev"},{"key":"e_1_2_10_14_1","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2020.01770","article-title":"The chimeric antigen receptor detection toolkit","volume":"11","author":"Hu Y","year":"2020","journal-title":"Front Immunol"},{"key":"e_1_2_10_15_1","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2022.830773","article-title":"Monitoring of circulating CAR T cells: validation of a flow cytometric assay, cellular kinetics, and phenotype analysis following tisagenlecleucel","volume":"13","author":"Peinelt A","year":"2022","journal-title":"Front Immunol"},{"issue":"4","key":"e_1_2_10_16_1","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.bbmt.2018.12.758","article-title":"ASTCT consensus grading for cytokine release syndrome and neurologic toxicity associated with immune effector cells","volume":"25","author":"Lee DW","year":"2019","journal-title":"Biol Blood Marrow Transplant"},{"issue":"1","key":"e_1_2_10_17_1","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1038\/nrclinonc.2017.148","article-title":"Chimeric antigen receptor T\u2010cell therapy\u2014assessment and management of toxicities","volume":"15","author":"Neelapu SS","year":"2018","journal-title":"Nat Rev Clin Oncol"},{"issue":"27","key":"e_1_2_10_18_1","doi-asserted-by":"crossref","first-page":"3119","DOI":"10.1200\/JCO.19.02104","article-title":"Standard\u2010of\u2010care axicabtagene ciloleucel for relapsed or refractory large B\u2010cell lymphoma: results from the US Lymphoma CAR T Consortium","volume":"38","author":"Nastoupil LJ","year":"2020","journal-title":"J Clin Oncol"},{"issue":"3","key":"e_1_2_10_19_1","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1111\/bjh.17673","article-title":"Earlier corticosteroid use for adverse event management in patients receiving axicabtagene ciloleucel for large B\u2010cell lymphoma","volume":"195","author":"Topp MS","year":"2021","journal-title":"Br J Haematol"},{"key":"e_1_2_10_20_1","doi-asserted-by":"crossref","first-page":"2122","DOI":"10.1182\/blood-2023-183002","article-title":"Real world experience with a Zuma\u20101 cohort 4 adopted approach to CRS and ICANS in CAR\u2010T recipients","volume":"142","author":"Sainatham C","year":"2023","journal-title":"Blood"},{"issue":"23","key":"e_1_2_10_21_1","doi-asserted-by":"crossref","first-page":"3272","DOI":"10.1182\/blood.2020008865","article-title":"Prognostic impact of corticosteroids on efficacy of chimeric antigen 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Glucocorticoids inhibit signal transduction through IL\u20102 receptor","volume":"151","author":"Paliogianni F","year":"1993","journal-title":"J Immunol"},{"key":"e_1_2_10_24_1","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1007\/s00018-005-5390-y","article-title":"Glucocorticoids in T cell apoptosis and function","volume":"63","author":"Herold M","year":"2006","journal-title":"Cell Mol Life Sci"},{"issue":"1","key":"e_1_2_10_25_1","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1186\/s12967-024-05063-4","article-title":"CAR T cells and T cells phenotype and function are impacted by glucocorticoid exposure with different magnitude","volume":"22","author":"Poiret T","year":"2024","journal-title":"J Transl Med"},{"issue":"2","key":"e_1_2_10_26_1","doi-asserted-by":"crossref","first-page":"382","DOI":"10.3390\/biom13020382","article-title":"Early use of corticosteroids following CAR T\u2010cell therapy correlates with reduced risk of high\u2010grade CRS without negative impact on neurotoxicity or treatment outcome","volume":"13","author":"Lakomy T","year":"2023","journal-title":"Biomolecules"},{"issue":"22","key":"e_1_2_10_27_1","doi-asserted-by":"crossref","first-page":"5607","DOI":"10.1182\/bloodadvances.2020003001","article-title":"Predictive factors of early progression after CAR T\u2010cell therapy in relapsed\/refractory diffuse large B\u2010cell lymphoma","volume":"4","author":"Vercellino L","year":"2020","journal-title":"Blood Adv"},{"issue":"3","key":"e_1_2_10_28_1","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.jtct.2020.10.022","article-title":"The international prognostic index is associated with outcomes in diffuse large B cell lymphoma after chimeric antigen receptor T cell therapy","volume":"27","author":"Garcia\u2010Recio M","year":"2021","journal-title":"Transplant Cell Ther"},{"issue":"9","key":"e_1_2_10_29_1","doi-asserted-by":"crossref","first-page":"2303","DOI":"10.1007\/s00277-021-04560-6","article-title":"Prognostic impact of total metabolic tumor volume in large B\u2010cell lymphoma patients receiving CAR T\u2010cell therapy","volume":"100","author":"Iacoboni G","year":"2021","journal-title":"Ann Hematol"},{"issue":"19","key":"e_1_2_10_30_1","doi-asserted-by":"crossref","first-page":"4898","DOI":"10.1182\/bloodadvances.2020002394","article-title":"Tumor burden, inflammation, and product attributes determine outcomes of axicabtagene ciloleucel in large B\u2010cell lymphoma","volume":"4","author":"Locke FL","year":"2020","journal-title":"Blood Adv"},{"key":"e_1_2_10_31_1","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2021.780442","article-title":"T cell fitness and autologous CAR T cell therapy in haematologic malignancy","volume":"12","author":"Mehta PH","year":"2021","journal-title":"Front Immunol"},{"key":"e_1_2_10_32_1","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2022.904497","article-title":"CAR T\u2010cell therapy predictive response markers in diffuse large B\u2010cell lymphoma and therapeutic options after CART19 failure","volume":"13","author":"Caballero AC","year":"2022","journal-title":"Front Immunol"},{"key":"e_1_2_10_33_1","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1182\/blood-2025-399","article-title":"A simple scoring system for response and toxicity following lymphoma CAR\u2010T: results from the Australian CAR\u2010T real\u2010world consortium","volume":"146","author":"Dowling M","year":"2025","journal-title":"Blood"},{"issue":"27","key":"e_1_2_10_34_1","doi-asserted-by":"crossref","first-page":"3059","DOI":"10.1200\/JCO.2013.54.8800","article-title":"Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non\u2010Hodgkin lymphoma: the Lugano classification","volume":"32","author":"Cheson BD","year":"2014","journal-title":"J Clin Oncol"},{"key":"e_1_2_10_35_1","unstructured":"Peter MacCallum Cancer Centre.A phase II open\u2010label multi\u2010centre study of minimal residual disease\u2010directed consolidation with Epcoritamab or Epcoritamab\u2010Lenalidomide\u2010rituximab post anti\u2010CD19 CAR T cell therapy for large B\u2010cell lymphoma (EpLCART).Melbourne Victoria Australia:Peter MacCallum Cancer Centre 2024. Available from:https:\/\/clinicaltrials.gov\/study\/NCT06414148. Accessed 17 June 2026."},{"issue":"9","key":"e_1_2_10_36_1","doi-asserted-by":"crossref","first-page":"1860","DOI":"10.1038\/s41591-022-01960-7","article-title":"Post\u2010infusion CAR TReg cells identify patients resistant to CD19\u2010CAR therapy","volume":"28","author":"Good Z","year":"2022","journal-title":"Nat Med"},{"key":"e_1_2_10_37_1","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2023.1108297","article-title":"Novel pathophysiological insights into CAR\u2010T cell associated neurotoxicity","volume":"14","author":"Genoud V","year":"2023","journal-title":"Front Neurol"},{"issue":"12","key":"e_1_2_10_38_1","doi-asserted-by":"crossref","first-page":"1404","DOI":"10.1158\/2159-8290.CD-17-0698","article-title":"Endothelial activation and blood\u2013brain barrier disruption in neurotoxicity after adoptive immunotherapy with CD19 CAR\u2010T cells","volume":"7","author":"Gust J","year":"2017","journal-title":"Cancer Discov"},{"issue":"3","key":"e_1_2_10_39_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.bict.2025.100020","article-title":"Predicting infection risk following CAR\u2010T using the bedside CAR\u2010HEMATOTOX score: performance in an Australian cohort","volume":"1","author":"Reynolds GK","year":"2025","journal-title":"Blood Immunol Cell Ther"},{"key":"e_1_2_10_40_1","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.cmi.2025.10.005","article-title":"Invasive fungal infections after CD19 chimeric antigen receptor T\u2010cell therapy for B\u2010cell lymphoma: a lymphoma study association study from the DESCAR\u2010T (Dispositif d'Enregistrement et Suivi des patients trait\u00e9s par CAR\u2010T cells) registry","volume":"32","author":"Bouvier A","year":"2025","journal-title":"Clin Microbiol Infect"}],"container-title":["British Journal of Haematology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bjh.70825","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/bjh.70825","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bjh.70825","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:10:10Z","timestamp":1788779410000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/bjh.70825"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,7]]},"references-count":39,"alternative-id":["10.1111\/bjh.70825"],"URL":"https:\/\/doi.org\/10.1111\/bjh.70825","archive":["Portico"],"relation":{},"ISSN":["0007-1048","1365-2141"],"issn-type":[{"value":"0007-1048","type":"print"},{"value":"1365-2141","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,7]]},"assertion":[{"value":"2026-06-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-21","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"bjh.70825"}}