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Chimeric Antigen Receptor (CAR) T cell therapy is an FDA approved treatment for diffuse large B cell lymphoma-not otherwise specified (DLBCL-NOS), primary mediastinal large B cell lymphoma (PMLBCL), high grade B-cell lymphoma, and DLBCL arising from follicular lymphoma with two commercial products currently in clinical use: Tisagenlecleucel and Axicabtagene ciloleucel (axi-cel). A number of products are in clinical trials for other indications including multiple myeloma. The long-term consequences of cellular therapy are largely unknown. Grade 3 or higher cytopenias have been reported in 17% of patients treated with axi-cell [1]. We sought to further characterize the duration and intensity of cytopenias following cellular therapy using commercial and research products i.e, axi-cell, anti-BCMA bb2121 and anti-BCMA bb21217. We also aimed to assess current practice regarding management of cytopenias in patients treated with cellular therapy. We evaluated patients with DLBCL and multiple myeloma treated at the Mount Sinai Hospital between April 2017 and September 2019. Counts at apheresis, and days 0, 7, 15, 30, 90 and 180 post-treatment were recorded. Administration of G-CSF, erythropoiesis-stimulating agents (ESA), thrombopoietin receptor agonists (TPO-agonist); and red blood cell and platelet transfusions between days 0 and 180 were also recorded. The data was censored at last follow up, progression or death. A total of fifty patients were identified; 41 with multiple myeloma and nine with DLBCL. At day 30, grade 3-4 neutropenia, anemia and thrombocytopenia were present in 54% (26/48), 17% (8/48) and 50% (24/48) of patients, respectively (table 1). G-CSF, ESA, TPO-agonist, PRBC and platelet utilization beyond day 30 is shown in table 2. 70.8% (34/48) patients required G-CSF support beyond day 30. Prolonged cytopenias can be seen in over 50% of patients beyond day 30 after cellular therapy and require frequent monitoring for management. By day 90, majority of the patients had improvement in their counts. We will be further examining data to determine the relationship of cytopenias with risk of infectious complications, antibiotic therapy utilization, re-hospitalization and duration of hospital stay. [ABSTRACT FROM AUTHOR]

Therapeutic strategies for multiple myeloma (MM) have changed dramatically over the past decade. Thus, the role of hematopoietic stem cell transplantation (HCT) must be considered in the context of this evolution. In this evidence-based review, we have critically analyzed the data from the most recent clinical trials to better understand how to incorporate HCT and when HCT is indicated. We have provided our recommendations based on strength of evidence with the knowledge that ongoing clinical trials make this a dynamic field. Within this document, we discuss the decision to proceed with autologous HCT, factors to consider before proceeding to HCT, the role of tandem autologous HCT, post-HCT maintenance therapy, and the role of allogeneic HCT for patients with MM. [ABSTRACT FROM AUTHOR]