Incidence and risk factors associated with a syndrome of persistent cytopenias after CAR-T cell therapy (PCTT)

George R. Nahas, Krishna V. Komanduri, Denise Pereira, Mark Goodman, Antonio M. Jimenez, Amer Beitinjaneh, Trent P. Wang, Lazaros J. Lekakis

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Anti-CD19 Chimeric Antigen Receptor T cells (CAR-T) have shown dramatic efficacy in treating refractory aggressive B cell Lymphomas leading to FDA approval of axicabtagene ciloleucel and tisagenlecleucel. While long-term remission rate for both is higher than 33%, this treatment is associated with life-threatening complications including cytokine-release syndrome, encephalopathy, and lethal cerebral edema. Here we describe a case series of bone marrow failure syndromes with or without co-existing clonal myelodysplastic syndrome. Bone marrow failure was defined as absolute neutrophil count (ANC) <500 neutrophils/μL day 42 after infusion of CAR-T cells or filgrastim support to reach that number. We use “persistent cytopenias after T-cell therapy (PCTT)” to describe this syndrome which has an incidence of 38% with axicabtagene ciloleucel. Platelets <75,000/μL at the time of initiation of lymphodepleting chemotherapy and occurrence of maximum severity of cytokine-release syndrome (CRS) on day 0 or 1 after infusion of CAR-T cells are independent predictors of PCTT.

Original languageEnglish (US)
Pages (from-to)940-943
Number of pages4
JournalLeukemia and Lymphoma
Volume61
Issue number4
DOIs
StatePublished - Mar 20 2020

Keywords

  • CAR-T cells
  • bone marrow failure
  • cytokine release syndrome
  • lymphoma

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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