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Hematopoietic stem cell boost for persistent neutropenia after CAR T-cell therapy: a GLA/DRST study.

Authors :
Gagelmann N
Wulf GG
Duell J
Glass B
van Heteren P
von Tresckow B
Fischer M
Penack O
Ayuk F
Einsele H
Holtick U
Thomson J
Dreger P
Kröger N
Source :
Blood advances [Blood Adv] 2023 Feb 28; Vol. 7 (4), pp. 555-559.
Publication Year :
2023

Abstract

Hematotoxicity after chimeric antigen receptor (CAR) T-cell therapy is associated with infection and death but management remains unclear. We report results of 31 patients receiving hematopoietic stem cell boost (HSCB; 30 autologous, 1 allogeneic) for either sustained severe neutropenia of grade 4 (<0.5 × 109/L), sustained moderate neutropenia (≤1.5 × 109/L) and high risk of infection, or neutrophil count ≤2.0 × 109/L and active infection. Median time from CAR T-cell therapy to HSCB was 43 days and median absolute neutrophil count at time of HSCB was 0.2. Median duration of neutropenia before HSCB was 38 days (range, 7-151). Overall neutrophil response rate (recovery or improvement) was observed in 26 patients (84%) within a median of 9 days (95% confidence interval, 7-14). Time to response was significantly associated with the duration of prior neutropenia (P = .007). All nonresponders died within the first year after HSCB. One-year overall survival for all patients was 59% and significantly different for neutropenia (≤38 days; 85%) vs neutropenia >38 days before HSCB (44%; P = .029). In conclusion, early or prophylactic HSCB showed quick response and improved outcomes for sustained moderate to severe neutropenia after CAR-T.<br /> (© 2023 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)

Details

Language :
English
ISSN :
2473-9537
Volume :
7
Issue :
4
Database :
MEDLINE
Journal :
Blood advances
Publication Type :
Academic Journal
Accession number :
35696759
Full Text :
https://doi.org/10.1182/bloodadvances.2022008042