Definition and incidence of prolonged cytopenias in the real-world setting
| Reference . | Disease . | Sample size . | Product . | Definition of prolonged, day . | Neutropenia . | Thrombocytopenia . | Comments . |
|---|---|---|---|---|---|---|---|
| Nahas et al. Leuk Lymph 202082 | LBCL | 21 | Axi-cel | 42 | 38% | - | 2 cases of MDS |
| Strati et al. Haematologica 202183 | LBCL | 31 | Axi-cel | 30 | 29% | 42% | MDS (n = 4)** |
| Fried et al. BMT 201914 | ALL, B-NHL | 35 | Local product/ CD19/CD28 | 42 | 62% | 44% | Biphasic neutropenia and thrombocytopenia; proposed mechanism for late CART cytopenia: SDF-1 alterations |
| Cordeiro et al. BBMT 202013 | ALL, B-NHL, CLL | 86 | Local product / CD19/4-1BB | 90 | 16% | - | 4 cases of MDS, long-lasting nature of cytopenia after CAR-T infusion |
| Jain et al. Blood Adv 202028 | BCL, ALL MM | 83 | Axi-cel, tisa-cel, local product | 90 | 20% | 10% | Delayed hematopoietic recovery associated with high-grade CRS/ICANS, MDS (n = 1)* |
| Rejeski et al. Blood 20218 | LBCL | 235 | Axi-cel, tisa-cel | 21 | 64% | - | Description of 3 typical neutrophil recovery phenotypes; thrombo-cytopenic nadir in month 2; development of CAR-HEMATOTOX score with independent validation |
| Wang et al. Front Oncol 202184 | ALL | 76 | Local product/ CD19; CD22/ 4-1BB | 80 | 70% | 48% | |
| Logue et al. Haematologica 202141 | LBCL | 85 | Axi-cel | 30 | 30% | 26% | Description of long-term immune reconstitution in LBCL patients treated with axi-cel |
| Logue et al. Blood Adv 202242 | MM | 52 | Ide-cel | 30 | 39% | 51% | Real-world data on hematotoxicity in multiple myeloma |
| Juluri et al. Blood Adv 202253 | ALL, B-NHL, CLL | 173 | Local product/ CD19/ 4-1BB | 28 | 9% | 14% | F/U (40 M): persistent neutropenia (9%) and thrombocytopenia (14%); association of hematotoxicity with high-grade CRS and CRS-related inflammatory patterns |
| Bethge et al. Blood 202285 | LBCL | 319 | Axi-cel, tisa-cel | 28/100 | 26%/10% | 67%/32% | Defined as absence of count recovery; delayed hematopoietic recovery associated with NRM |
| Bachy et al. Nat Med 202220 | DLBCL | 418 | Axi-cel, tisa-cel | 30/90 | 17%/6% | 16%/5% | Matched-paired comparison of CAR products; increased hematotoxicity incidence with axi-cel > tisa-cel |
| Penack et al. JITC 202386 | LBCL | 398 | Axi-cel, tisa-cel | 30/100 | severe (CTC grade ≥3) cytopenia: 9%/12% | Association between number of prior treatment lines and incidence of cytopenia | |
| Reference . | Disease . | Sample size . | Product . | Definition of prolonged, day . | Neutropenia . | Thrombocytopenia . | Comments . |
|---|---|---|---|---|---|---|---|
| Nahas et al. Leuk Lymph 202082 | LBCL | 21 | Axi-cel | 42 | 38% | - | 2 cases of MDS |
| Strati et al. Haematologica 202183 | LBCL | 31 | Axi-cel | 30 | 29% | 42% | MDS (n = 4)** |
| Fried et al. BMT 201914 | ALL, B-NHL | 35 | Local product/ CD19/CD28 | 42 | 62% | 44% | Biphasic neutropenia and thrombocytopenia; proposed mechanism for late CART cytopenia: SDF-1 alterations |
| Cordeiro et al. BBMT 202013 | ALL, B-NHL, CLL | 86 | Local product / CD19/4-1BB | 90 | 16% | - | 4 cases of MDS, long-lasting nature of cytopenia after CAR-T infusion |
| Jain et al. Blood Adv 202028 | BCL, ALL MM | 83 | Axi-cel, tisa-cel, local product | 90 | 20% | 10% | Delayed hematopoietic recovery associated with high-grade CRS/ICANS, MDS (n = 1)* |
| Rejeski et al. Blood 20218 | LBCL | 235 | Axi-cel, tisa-cel | 21 | 64% | - | Description of 3 typical neutrophil recovery phenotypes; thrombo-cytopenic nadir in month 2; development of CAR-HEMATOTOX score with independent validation |
| Wang et al. Front Oncol 202184 | ALL | 76 | Local product/ CD19; CD22/ 4-1BB | 80 | 70% | 48% | |
| Logue et al. Haematologica 202141 | LBCL | 85 | Axi-cel | 30 | 30% | 26% | Description of long-term immune reconstitution in LBCL patients treated with axi-cel |
| Logue et al. Blood Adv 202242 | MM | 52 | Ide-cel | 30 | 39% | 51% | Real-world data on hematotoxicity in multiple myeloma |
| Juluri et al. Blood Adv 202253 | ALL, B-NHL, CLL | 173 | Local product/ CD19/ 4-1BB | 28 | 9% | 14% | F/U (40 M): persistent neutropenia (9%) and thrombocytopenia (14%); association of hematotoxicity with high-grade CRS and CRS-related inflammatory patterns |
| Bethge et al. Blood 202285 | LBCL | 319 | Axi-cel, tisa-cel | 28/100 | 26%/10% | 67%/32% | Defined as absence of count recovery; delayed hematopoietic recovery associated with NRM |
| Bachy et al. Nat Med 202220 | DLBCL | 418 | Axi-cel, tisa-cel | 30/90 | 17%/6% | 16%/5% | Matched-paired comparison of CAR products; increased hematotoxicity incidence with axi-cel > tisa-cel |
| Penack et al. JITC 202386 | LBCL | 398 | Axi-cel, tisa-cel | 30/100 | severe (CTC grade ≥3) cytopenia: 9%/12% | Association between number of prior treatment lines and incidence of cytopenia | |
Axi-cel , axicabtagene ciloleucel; ALL , acute lymphoblastic leukemia; BCL, B-cell lymphoma; BCMA, B-cell maturation antigen; B-NHL, B-cell non-Hodgkin lymphoma; brexu-cel, brexucabtagene autoleucel; CD, cluster of differentiation; CLL, chronic lymphocytic leukemia; CRS, cytokine release syndrome; d , day; DLBCL , diffuse large B-cell lymphoma; F/U , follow-up; G, grade; ide-cel, idecabtagene vicleucel; ICANS, immune effector cell-associated neurotoxicity syndrome; M , month; M1 , neutropenia/thrombocytopenia at 1 month; MDS, myelodysplastic syndrome; MM, multiple myeloma; NHL, non-Hodgkin lymphoma; NRM, non-relapse mortality; LBCL , large B-cell lymphoma; SDF-1 , stromal cell-derived factor 1; tisa-cel, tisagenlecleucel.
MDS diagnosed in relapse after CAR-T-cell treatment.
No difference in MDS incidence between patients with and without >G3 cytopenia at M1.
Adapted with permission from Rejeski, Subklewe et al, Blood. 2023.9