Cytopenias after Chimeric Antigen Receptor T-Cells (CAR-T) Infusion; Patterns and Outcomes

Schaefer, Andrew P.; Saygin, Caner; Maakaron, Joseph; Hoelscher, Tara; Purdin, Zebulun; Robinson, Jacquela; Lamprecht, Misty; Penza, Sam; Brammer, Jonathan E.; Efebera, Yvonne A.; Benson, Don M.; Vasu, Sumithira; Mims, Alice S.; Blaser, Bradley W.; Choe, Hannah; Larkin, Karilyn; Long, Meixiao; Rosko, Ashley; Grieselhuber, Nicole R.; Wall, Sarah; Jaglowski, Samantha; William, Basem M.

doi:10.1016/j.bbmt.2018.12.311

Cited by 20 publications

(19 citation statements)

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“…Outside clinical trials, persistent neutropenia, anemia and thrombocytopenia for at least 28 days after CAR‐T cell therapy was seen in 9%, 72% and 65%, respectively. Median time to neutrophil, hemoglobin and platelets recovery were 11, 76 and 60 days, respectively . Similar findings were reported in another study .…”

supporting

confidence: 90%

“…Other side effects include temporary cytopenias, infections, elevated liver enzymes and hypogammaglobulinemia . Prolonged and persistent cytopenias have been also reported . We report a case of severe and persistent bone marrow aplasia after CAR T‐cell therapy for relapsed diffuse large B‐cell lymphoma, which necessitated an allogeneic hematopoietic stem cell transplantation (allo‐HSCT).…”

mentioning

confidence: 96%

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Allogenic hematopoietic stem cell transplantation for prolonged bone marrow aplasia after chimeric antigen receptor (CAR) T‐cell therapy for relapsed diffuse large B‐cell lymphoma

et al. 2020

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supporting

confidence: 90%

mentioning

confidence: 96%

Allogenic hematopoietic stem cell transplantation for prolonged bone marrow aplasia after chimeric antigen receptor (CAR) T‐cell therapy for relapsed diffuse large B‐cell lymphoma

et al. 2020

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“…For persistent neutropenia (ANC<500 cells/µL) after day 28 following CAR T cell infusion, growth factors should be considered (LE: 4 134 ).…”

Section: Cytopeniasmentioning

confidence: 99%

Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immune effector cell-related adverse events

Maus

Alexander

Bishop

et al. 2020

J Immunother Cancer

178

233

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Immune effector cell (IEC) therapies offer durable and sustained remissions in significant numbers of patients with hematological cancers. While these unique immunotherapies have improved outcomes for pediatric and adult patients in a number of disease states, as ‘living drugs,’ their toxicity profiles, including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), differ markedly from conventional cancer therapeutics. At the time of article preparation, the US Food and Drug Administration (FDA) has approved tisagenlecleucel, axicabtagene ciloleucel, and brexucabtagene autoleucel, all of which are IEC therapies based on genetically modified T cells engineered to express chimeric antigen receptors (CARs), and additional products are expected to reach marketing authorization soon and to enter clinical development in due course. As IEC therapies, especially CAR T cell therapies, enter more widespread clinical use, there is a need for clear, cohesive recommendations on toxicity management, motivating the Society for Immunotherapy of Cancer (SITC) to convene an expert panel to develop a clinical practice guideline. The panel discussed the recognition and management of common toxicities in the context of IEC treatment, including baseline laboratory parameters for monitoring, timing to onset, and pharmacological interventions, ultimately forming evidence- and consensus-based recommendations to assist medical professionals in decision-making and to improve outcomes for patients.

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“…Patients often need RBC and platelet transfusion support within the first 3 months of therapy. [174][175][176] Open access other considerations ► CAR T cell safety when CrCl is <20 mL/min has not been assessed and the majority of the panel would not feel comfortable recommending CAR T therapy for patients with renal failure or significant hepatic impairment.…”

Section: Panel Recommendationsmentioning

confidence: 99%

The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of multiple myeloma

Shah

Aiello

Avigan

et al. 2020

J Immunother Cancer

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Outcomes in multiple myeloma (MM) have improved dramatically in the last two decades with the advent of novel therapies including immunomodulatory agents (IMiDs), proteasome inhibitors and monoclonal antibodies. In recent years, immunotherapy for the treatment of MM has advanced rapidly, with the approval of new targeted agents and monoclonal antibodies directed against myeloma cell-surface antigens, as well as maturing data from late stage trials of chimeric antigen receptor CAR T cells. Therapies that engage the immune system to treat myeloma offer significant clinical benefits with durable responses and manageable toxicity profiles, however, the appropriate use of these immunotherapy agents can present unique challenges for practicing physicians. Therefore, the Society for Immunotherapy of Cancer convened an expert panel, which met to consider the current role of approved and emerging immunotherapy agents in MM and provide guidance to the oncology community by developing consensus recommendations. As immunotherapy evolves as a therapeutic option for the treatment of MM, these guidelines will be updated.

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Cytopenias after Chimeric Antigen Receptor T-Cells (CAR-T) Infusion; Patterns and Outcomes

Cited by 20 publications

References 0 publications

Allogenic hematopoietic stem cell transplantation for prolonged bone marrow aplasia after chimeric antigen receptor (CAR) T‐cell therapy for relapsed diffuse large B‐cell lymphoma

Allogenic hematopoietic stem cell transplantation for prolonged bone marrow aplasia after chimeric antigen receptor (CAR) T‐cell therapy for relapsed diffuse large B‐cell lymphoma

Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immune effector cell-related adverse events

The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of multiple myeloma

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