Transfusion needs after CAR T-cell therapy for large B-cell lymphoma: predictive factors and outcome (a DESCAR-T study).
Samuel VicJean-Baptiste ThibertEmmanuel BachyGuillaume CartronThomas GastinneJudith TrotmanFabien Le BrasKamal BouabdallahFabien DespasJacques-Olivier BayMarie-Thérèse RubioMohamad MohtyRené-Olivier CasasnovasSylvain ChoquetCristina Castilla-LlorenteStéphanie GuidezMichael LoschiBlandine GuffroySylvain CarrasLaurianne Drieu La RochelleMathilde GuilletHouot RochPublished in: Blood advances (2024)
Chimeric antigen receptor (CAR) T-cells targeting CD19 have been approved for the treatment of relapse/refractory large B-cell lymphoma. Hematotoxicity is the most frequent CAR T-cell-related adverse event. Transfusion support is a surrogate marker of severe cytopenias. Transfusion affects patients' quality of life, presents specific toxicities, and is known to affect immunity through the so-called transfusion-related immunomodulation that may affect CAR T-cell efficacy. We analyzed data from 671 patients from the French DESCAR-T registry for whom exhaustive transfusion data were available. Overall, 401 (59.8%) and 378 (56.3%) patients received transfusion in the 6-month period before and after CAR T-cell infusion, respectively. The number of patients receiving transfusion and the mean number of transfused products increased during the 6-month period before CAR T-cell infusion, peaked during the first month after infusion (early phase), and decreased over time. Predictive factors for transfusion at the early phase were age >60 years, ECOG PS ≥2, treatment with axicabtagene ciloleucel, pre-CAR T-cell transfusions, and CAR-HEMATOTOX score ≥2. Predictive factors for late transfusion (between 1 and 6 months after infusion) were pre-CAR T-cell transfusions, CAR-HEMATOTOX score ≥2, ICANS ≥3 (for red blood cells [RBC] transfusion), and tocilizumab use (for platelets transfusion). Early transfusions and late platelets (but not RBC) transfusions were associated with a shorter progression-free survival and overall survival. Lymphoma-related mortality and nonrelapse mortality were both increased in the transfused population. Our data shed light on the mechanisms of early and late cytopenia and on the potential impact of transfusions on CAR T-cell efficacy and toxicity.
Keyphrases
- cardiac surgery
- red blood cell
- sickle cell disease
- end stage renal disease
- ejection fraction
- chronic kidney disease
- free survival
- newly diagnosed
- cell therapy
- low dose
- acute kidney injury
- prognostic factors
- stem cells
- diffuse large b cell lymphoma
- oxidative stress
- mesenchymal stem cells
- emergency department
- cardiovascular disease
- bone marrow
- machine learning
- risk factors
- systemic lupus erythematosus
- patient reported outcomes
- combination therapy
- data analysis