ArticlemedRxiv : the preprint server for health sciences2025
Diurnal rhythms in chimeric antigen receptor T cell performance: an observational study of 670 patients.
Article in medRxiv : the preprint server for health sciences, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
- Updated by
Authors and funding
14 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Chimeric antigen receptor (CAR) T cells are a leading immunotherapy for refractory B-cell malignancies, but their impact is constrained by toxicity and incomplete long-term efficacy. Daily (circadian) rhythms in immune function may offer a lever to boost therapeutic success. Studies suggest that time of day influences immune-based therapies, including vaccines, hematopoietic stem cell transplantation, and checkpoint inhibitors for cancer. However, the clinical relevance of biological rhythms to CAR-T cell therapy remains unknown. Methods: We retrospectively analyzed CAR-T cell survival and complications based on infusion time at two geographically distinct hospitals in St. Louis, Missouri (n=363), and Portland, Oregon (n=307) between 2018 and 2024. The primary outcome was 90-day overall survival (OS). Secondary outcomes included event-free survival (EFS), cytokine release syndrome (CRS), immune cell-associated neurotoxicity syndrome (ICANS), ICU admission, shock, respiratory failure, and infection. We quantified the independent relationship between infusion time and outcomes using multivariable mixed effects logistic regression, adjusting for patient, oncological, and treatment characteristics. Findings: Morning CAR-T cell infusions were associated with higher overall survival and lower rates of neurotoxicity before and after adjusting for confounders. Each hour earlier in the day that CAR-T cell treatment was given corresponded to a 22% increase in the odds of 90-day OS (adjusted odds ratio [aOR] 0·78, 95% CI 0·66-0·92, p=0·004). Simultaneously, for every hour CAR-T cell infusion was delayed, the adjusted odds of severe ICANS rose by 17% (aOR 1·17, 95% CI 1·01-1·34, p=0·031), and anakinra prescription rose by 26% (aOR 1·26, 95% CI 1·07-1·49, p=0·006). In contrast, we did not find an association between infusion time and severe CRS (aOR 0·96, 95% CI 0·74-1·23, p=0·73). Temporal patterns were most pronounced in women and patients receiving CD19-targeting CAR-T cell products for leukemia or lymphoma. Interpretation: Time of day is a potent and easily modifiable factor that could optimize CAR-T cell clinical performance. Funding: National Institutes of Health. Research in context:
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.