[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [CAR T-cell therapies](https://durgical.com/en/pharmacology/classes/car-t-cell-therapies/) › Axicabtagene ciloleucel

# Axicabtagene ciloleucel

## CAR T-cell therapies?

CAR T-cell therapies

## High alert?

An error with this medicine can cause serious harm: double checks and protocols are used.

Anti-CD19 CAR T-cell therapy for large B-cell and follicular lymphoma, given as one infusion. Boxed risks: cytokine release syndrome and neurotoxicity.

Updated Nov 1, 2026

Also called: axi-cel

## Quick facts

**Group**
[CAR T-cell therapies](https://durgical.com/en/pharmacology/classes/car-t-cell-therapies/)

**Target**
CD19 on normal and malignant B cells

**Used for**
Large B-cell lymphoma

**Key effects**
Fever · Low blood pressure and fast heartbeat

**Monitor**
Neurological checks · Complete blood count and signs

**ATC**
L01XL03

No doses: the clinician sets them by the current guideline.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Clinical What the labels mean

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## 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.

- T cells collected and engineered with an anti-CD19 CAR
- Lymphodepleting chemotherapy, then one infusion
- CAR T cells bind CD19 and kill lymphoma cells
- 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 →](https://durgical.com/en/conditions/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

### Serious (rare, important)

- Cytokine release syndrome, which can be fatal (boxed warning)
- Neurological toxicity: confusion, speech problems, seizures (boxed warning)
- Secondary blood cancers, including T-cell malignancies (boxed warning)
- Serious infections and low blood counts with bleeding
- Hypersensitivity reactions

## 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.

## Memory aid

«AXI-cel is an AXE for CD19»: one infusion, then watch for «Fever and Fog» (CRS and neurotoxicity).

## Test yourself

Think of the answer, then tap the question to see it.

## Which antigen does axicabtagene ciloleucel target?

CD19 on B cells.

## Which lymphoma is the main indication of axicabtagene ciloleucel?

Large B-cell lymphoma that is refractory or has relapsed.

## What must happen before the CAR T cells are infused?

Lymphodepleting chemotherapy, after the T cells were collected and engineered.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/axicabtagene-ciloleucel/)

[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## What the labels mean

**High alert**
An error with this medicine can cause serious harm: double checks and protocols are used.

## Connections

## Related drugs 2

- [Tisagenlecleucel](https://durgical.com/en/pharmacology/tisagenlecleucel/)
- [Tocilizumab](https://durgical.com/en/pharmacology/tocilizumab/)

## Related conditions 1

- [Non-Hodgkin lymphoma](https://durgical.com/en/conditions/non-hodgkin-lymphoma/)

[← Back to the class: CAR T-cell therapies](https://durgical.com/en/pharmacology/classes/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](https://medlineplus.gov/druginfo/meds/a618003.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [Axicabtagene Ciloleucel - NCI](https://www.cancer.gov/about-cancer/treatment/drugs/axicabtageneciloleucel) (National Cancer Institute, 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=L01XL03) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/axicabtagene-ciloleucel/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/axicabtagene-ciloleucel/