Cancer Management and Research (Nov 2021)

Cytopenias After CD19 Chimeric Antigen Receptor T-Cells (CAR-T) Therapy for Diffuse Large B-Cell Lymphomas or Transformed Follicular Lymphoma: A Single Institution Experience

  • Schaefer A,
  • Huang Y,
  • Kittai A,
  • Maakaron JE,
  • Saygin C,
  • Brammer J,
  • Penza S,
  • Saad A,
  • Jaglowski SM,
  • William BM

Journal volume & issue
Vol. Volume 13
pp. 8901 – 8906

Abstract

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Andrew Schaefer,1 Ying Huang,2 Adam Kittai,2 Joseph E Maakaron,3 Caner Saygin,4 Jonathan Brammer,2 Sam Penza,2 Ayman Saad,2 Samantha M Jaglowski,2 Basem M William5 1Department of Medicine, University of Wisconsin, Madison, WI, USA; 2Department of Internal Medicine, The Ohio State University, Columbus, OH, USA; 3Department of Medicine, University of Minnesota, Minneapolis, MN, USA; 4Department of Medicine, University of Chicago, Chicago, IL, USA; 5OhioHealth Blood and Marrow Transplant Program, Columbus, OH, USACorrespondence: Basem M WilliamOhioHealth Blood and Marrow Transplant Program, 500 Thomas Lane, Columbus, OH, 43214, USAEmail [email protected]: Patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) have poor outcomes. Treatment with CD19 chimeric antigen receptor (CAR-T) cells, tisagenlecleucel and axicabtagene ciloleucel, has been associated with improved outcomes. Cytopenias were observed in clinical trials with both products; however, little is known regarding the patterns and outcomes of these cytopenias.Subjects and Methods: We reviewed DLBCL patients (n=32) receiving either product between January and September 2018 at our institution.Results: Median duration of leukopenia, neutropenia, lymphopenia, anemia, and thrombocytopenia was 49, 9, 117.5, 125, and 95.5 days after CAR-T infusion, respectively. Filgrastim was used in 63% of patients, and 50% of patients received red cell or platelet transfusions. With the exception of neutropenia, increase in the duration of cytopenia of any lineage was associated with improvement in progression-free survival, and in overall survival in case of anemia. There was no association between the duration of cytopenias with either cytokine release syndrome or neurotoxicity.Discussion: Our data suggest a correlation between cytopenias and survival outcomes after CD19 CAR-T therapy. If validated, cytopenia may be proven useful as a biomarker of response and survival after CAR-T therapy.Keywords: diffuse large B-cell lymphoma, transformed follicular lymphomas, chimeric antigen receptor T-cells, immunotherapy, cytopenias

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