Axicabtagene ciloleucel

Mechanism of action

The patient's own T cells are engineered to express a chimeric antigen receptor directed against CD19. After lymphodepleting chemotherapy and a single infusion, the CAR T cells bind CD19 on lymphoma cells independently of MHC, become activated, kill the B cells and multiply; the activation releases cytokines responsible for cytokine release syndrome.

1. T cells collected and engineered with an anti-CD19 CAR
2. Lymphodepleting chemotherapy, then one infusion
3. CAR T cells bind CD19 and kill lymphoma cells
4. Activation releases cytokines (CRS risk)

Indications

• Large B-cell lymphoma (including diffuse large B-cell, primary mediastinal and high-grade B-cell lymphoma) that is refractory to or relapses soon after first-line chemoimmunotherapy, or after two or more lines; relapsed or refractory follicular lymphoma. Non-Hodgkin lymphoma →

Adverse effects

Common

• Fever
• Low blood pressure and fast heartbeat
• Fatigue, nausea, diarrhoea, decreased appetite
• Headache, joint or muscle pain
• Low blood counts

Contraindications

• Known allergy to components of the product
• Active uncontrolled infection is treated before infusion

Key interactions

Live vaccines

Not given for weeks before lymphodepleting chemotherapy, during treatment or until immune recovery.

Corticosteroids

Suppress T cells; used on purpose to treat severe CRS or neurotoxicity, otherwise avoided unless needed.

What is monitored

• Vital signs and oxygen saturation frequently after infusion
• Neurological checks
• Complete blood count and signs of infection
• History of seizures, stroke or memory problems before treatment
• Long-term follow-up for new cancers

Administration and safety

• Given only at certified centres within the FDA risk management programme (REMS).
• Patient identity is checked against the bag label: the product is made for one patient only.
• Thawed and infused intravenously as a single dose; premedication is given as ordered.
• Tocilizumab and emergency equipment are available before the infusion.

Pregnancy and breastfeeding

A pregnancy test is done before treatment, and pregnancy or breastfeeding is discussed with the team.

Nursing care

• Monitor temperature, blood pressure and oxygen saturation; report fever or hypotension at once.
• Do neurological checks and report confusion, drowsiness or speech changes.
• Watch for infection and bleeding.
• Teaching: stay near the centre for at least two weeks, do not drive for at least two weeks, do not donate blood, organs or cells, and keep all appointments.

Pharmacokinetics

Distribution

The cells expand in the blood in the first weeks after infusion.

Elimination

A living product that can persist in the body.

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Connections

← Back to the class: CAR T-cell therapies

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: Axicabtagene Ciloleucel Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); Axicabtagene Ciloleucel - NCI (National Cancer Institute, 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.