Chinese expert consensus on the management of chimeric antigen receptor T cell therapy-associated coagulopathy

Mei, Heng; Chen, Fangping; Han, Yue; Hou, Ming; Huang, He; Huang, Xiao‐Jun; Li, Yuhua; Liang, Aibin; Liu, Qifa; Niu, Ting; Peng, Jun; Qian, W.; Song, Yongping; Wang, Jianxiang; Wang, Ying; Wu, Depei; Xu, Kailin; Yang, Lianjuan; Yang, Renchi; Zhang, Lei; Zhang, Liansheng; Zhang, Xi; Zhang, Xiaohui; Zhao, Wei‐Li; Han, Weidong; Hu, Yu

doi:10.1097/cm9.0000000000002288

Cited by 8 publications

(15 citation statements)

References 4 publications

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“…As reported by many studies, CARAC may become the third most common complication of CAR-T, with a 50%-56.6% incidence. Accompanying CRS, CARAC usually occurs in patients within 28 days (mostly 6-10 days) after CAR-T infusion, particularly in patients with poor vascular condition before infusion, highdose CAR-T cells, high tumor burden or severe CRS [39][40][41][42]. The pathophysiological mechanism of CARAC…”

Section: Caracmentioning

confidence: 99%

“…Bleeding (19.6%) and hypofibrinogenemia are the most common symptoms of CARAC, and comprise primarily gastrointestinal, extensive maxillofacial and intracranial hemorrhage [42][43][44]. Among patients with CARAC, 14%-50% may show progression to DIC, particularly those with grade 3-5 CRS [39,40,44,45].…”

Section: Hematology and Oncology Discoverymentioning

confidence: 99%

“…Thrombotic events also occur frequently (6.3%-8.8%), involving pulmonary embolism, deep vein thrombosis, thrombotic stroke and visceral veins [46,47]. Features include progressive decrease in platelet count, prolonged activated partial thromboplastin time, prothrombin time, hypofibrinogenemia, elevated D-dimer and fibrin degradation products, and similar cytokine profiles to those in CRS [42][43][44]48]. In addition to ASTCT criteria, which can be used to infer the occurrence of CARAC by assessing the severity of CRS, the Chinese expert consensus on the management of CARAC suggests that the Chinese DIC Scoring System (CDSS) or International Society on Thrombosis and Haemostasis DIC Scoring System and WHO bleeding scale can be used to evaluate the CARAC severity and predict DIC [42,[49][50][51].…”

Section: Hematology and Oncology Discoverymentioning

confidence: 99%

“…Because CARAC occurs and resolves after CRS, early identification of CRS and abnormal coagulation markers is crucial for the management of CARAC [42]. Corticosteroids and tocilizumab can be used in cases of concurrent CRS.…”

Section: Hematology and Oncology Discoverymentioning

confidence: 99%

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Whole-process management of complications during CAR-T therapy

Mei

2022

Hematology and Oncology Discovery

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Chimeric antigen receptor T cell (CAR-T) therapy has substantial efficacy in the treatment of relapsed and/or refractory hematological malignancies. However, despite this outstanding performance, various CAR-T complications challenge treatment success during the entire process of CAR-T therapy. Short-term (within 28 days) complications with a high incidence include cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome and CAR-T associated coagulopathy. Many other complications may also occur during mid- (28–100 days) and long-term (>100 days) follow-up. Determining how to identify and standardize the management of adverse events in CAR-T therapy in an accurately and timely manner is crucial for its wide application. This review focuses on time periods after CAR-T cell therapy, and discusses the occurrence and management of adverse events, with an aim to improve the safety management of CAR-T cell therapy.

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Section: Caracmentioning

confidence: 99%

Section: Hematology and Oncology Discoverymentioning

confidence: 99%

Section: Hematology and Oncology Discoverymentioning

confidence: 99%

Section: Hematology and Oncology Discoverymentioning

confidence: 99%

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Whole-process management of complications during CAR-T therapy

Mei

2022

Hematology and Oncology Discovery

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“…The patient management followed the published guideline. [3] Whether the recipient received a human leukocyte antigen (HLA)-identical or haploidentical HSCT was based on the donor selection criteria of our institution [Supplementary Methods, http://links.lww.com/CM9/B667].…”

mentioning

confidence: 99%

Bridging chimeric antigen receptor T-cell before transplantation improves prognosis of relapsed/refractory B-cell acute lymphoblastic leukemia

Zhao

Cheng

et al. 2023

Chinese Medical Journal

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A comprehensive analysis of coagulopathy during anti‐B cell maturation antigen chimeric antigen receptor‐T therapy in multiple myeloma, a retrospective study based on LEGEND‐2

Liu

et al. 2023

Hematological Oncology

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Chimeric antigen receptor (CAR)‐reprogrammed T cell therapy is a novel and powerful treatment against hematological malignancies. Cytokine release syndrome (CRS) and other potentially life‐threatening toxicities are known side effects which need appropriate management and supportive care. Coagulopathy is a common and severe CAR‐T‐related adverse event, while a comprehensive profile of coagulopathy in patients with multiple myeloma (MM) undergoing CAR‐T cell therapy has not been reported. Therefore, we performed a comprehensive analysis of coagulopathy in 51 patients with r/r MM given anti‐B cell maturation antigen CAR‐T cell therapy. We found that 49% of patients had coagulation disorders, and 29% of patients experienced disseminated intravascular coagulation (DIC). Severe CRS, abnormal liver function and higher tumor burden were risk factors for the CAR‐T‐related coagulopathy. We found that the serum IL‐6 level and alanine aminotransferase level were potential indicators for CAR‐T‐related DIC. Furthermore, we found that coagulation disorders occurred within 1 month after CAR‐T cell infusion, mainly between days 10 and 13, which was 2−5 days later than the beginning of CRS and simultaneous with the beginning of abnormal liver function and the peak of CRS. In addition, although patients with coagulation dysfunction had a trend for better outcomes and prognosis, no statistical significance was found. In conclusion, our research provided a comprehensive understanding of CAR‐T‐related coagulopathy in MM. Upon timely and standardized treatment, coagulopathy was manageable in most cases.

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Chinese expert consensus on the management of chimeric antigen receptor T cell therapy-associated coagulopathy

Abstract: Epigenetic connection between gut microbiota-derived short-chain fatty acids and chromatin histone modification in kidney diseases

Cited by 8 publications

References 4 publications

Whole-process management of complications during CAR-T therapy

Whole-process management of complications during CAR-T therapy

Bridging chimeric antigen receptor T-cell before transplantation improves prognosis of relapsed/refractory B-cell acute lymphoblastic leukemia

A comprehensive analysis of coagulopathy during anti‐B cell maturation antigen chimeric antigen receptor‐T therapy in multiple myeloma, a retrospective study based on LEGEND‐2

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