Hematopoietic stem cell boost for persistent neutropenia after CAR-T cell therapy: a GLA/DRST study
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Hematopoietic stem cell boost for persistent neutropenia after CAR-T cell therapy: a GLA/DRST study. / Gagelmann, Nico; Wulf, Gerald Georg; Duell, Johannes; Glass, Bertram; Heteren, Pearl van; von Tresckow, Bastian; Fischer, Monika; Penack, Olaf; Ayuk, Francis A; Einsele, Hermann; Holtick, Udo; Thomson, Julia; Dreger, Peter; Kröger, Nicolaus.
In: BLOOD ADV, Vol. 7, No. 4, 28.02.2023, p. 555-559.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Hematopoietic stem cell boost for persistent neutropenia after CAR-T cell therapy: a GLA/DRST study
AU - Gagelmann, Nico
AU - Wulf, Gerald Georg
AU - Duell, Johannes
AU - Glass, Bertram
AU - Heteren, Pearl van
AU - von Tresckow, Bastian
AU - Fischer, Monika
AU - Penack, Olaf
AU - Ayuk, Francis A
AU - Einsele, Hermann
AU - Holtick, Udo
AU - Thomson, Julia
AU - Dreger, Peter
AU - Kröger, Nicolaus
N1 - Copyright © 2022 American Society of Hematology.
PY - 2023/2/28
Y1 - 2023/2/28
N2 - 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.
AB - 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.
U2 - 10.1182/bloodadvances.2022008042
DO - 10.1182/bloodadvances.2022008042
M3 - SCORING: Journal article
C2 - 35696759
VL - 7
SP - 555
EP - 559
JO - BLOOD ADV
JF - BLOOD ADV
SN - 2473-9529
IS - 4
ER -
