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CD34 + -selected stem cell boost can safely improve cytopenias following CAR T-cell therapy

2022; Elsevier BV; Volume: 6; Issue: 16 Linguagem: Inglês

10.1182/bloodadvances.2022007572

2473-9537

Khushnuma Mullanfiroze, Arina Lazareva, Jan Chu, Lindsey Williams, Saskia Burridge, Juliana Silva, Robert Chiesa, Kanchan Rao, Giovanna Lucchini, Sara Ghorashian, Maeve O’Reilly, Ben Carpenter, Victoria Grandage, Rachael Hough, Claire Roddie, Persis Amrolia,

Nanowire Synthesis and Applications

2][3][4] Prolonged cytopenias are an underrecognized toxicity of CAR T-cell therapy.For example, in the ELIANA study, 41% and 53% of patients demonstrated grade 3 to 4 thrombocytopenia and neutropenia, respectively, persisting beyond day 30.Impaired hematological recovery after CAR T-cell therapy can lead to susceptibility to opportunistic infections, bleeding, and/or transfusion dependence, causing significant morbidity and mortality. 5Pre-CAR T-cell therapy lymphodepletion causes cytopenia that generally recovers in most patients within a month after CAR T-cell therapy.However, a proportion of patients develop persistent cytopenia, particularly neutropenia, associated with bone marrow (BM) hypoplasia that can persist for several months after CAR T-cell therpay. 6We hypothesized that for those patients who have undergone allogeneic SCT before CAR T-cell therapy and develop persistent cytopenia after CAR-T cell therapy, an unconditioned CD34 1 -selected stem-cell boost (SCB) from the SCT donor could be used to improve the cytopenia, similar to its use in those who have poor graft function after SCT. 7 We hereby report the outcomes of patients receiving SCB for persistent cytopenia after CAR T-cell therapy.A cohort of 101 pediatric and young adults from 2 centers in the United Kingdom with r/r B-ALL were treated with CAR T-cell therapy from May 2016 through December 2021.Of those patients, 2 were not evaluable for assessment of cytopenias after day 128 of CAR infusion (1 died on post-infusion day 4, and 1 had a morphological relapse on day 28).Of the 99 evaluable patients, 52 had undergone SCT before CAR therapy and 23 (44.2%) of them developed grade 3 to 4 cytopenia.Of the 47 patients who did not undergo an SCT, 23 (48.9%) developed grade 3 to 4 cytopenia.The difference in the rate of cytopenia between the 2 groups was not significant (P 5 .5999).