Hematopoiesis and immune reconstitution after CD19 directed chimeric antigen receptor T-cells (CAR-T): A comprehensive review on incidence, risk factors and current management.
Eugenio GalliAlberto FresaSilvia BellesiElisabetta MetafuniElena MaioloIlaria PansiniFilippo FrioniFrancesco AutoreMaria Assunta LimongielloIdanna InnocentiSabrina GiammarcoPatrizia ChiusoloGina ZiniFederica SoràPublished in: European journal of haematology (2023)
Impaired function of hematopoiesis after treatment with chimeric antigen T-cells (CAR-T) is a frequent finding and can interest a wide range of patients, regardless of age and underlying disease. Trilinear cytopenias, as well as hypogammaglobulinemia, B-cell aplasia, and T-cell impairment, can severely affect the infectious risk of CAR-T recipients, as well as their quality of life. In this review, we provide an overview of defects in hematopoiesis after CAR-T, starting with a summary of different definitions and thresholds. We then move to summarize the main pathogenetic mechanisms of cytopenias, and we offer insight into cytomorphological aspects, the role of clonal hematopoiesis, and the risk of secondary myeloid malignancies. Subsequently, we expose the major findings and reports on T-cell and B-cell quantitative and functional impairment after CAR-T. Finally, we provide an overview of current recommendations and leading experiences regarding the management of cytopenias and defective B- and T-cell function.
Keyphrases
- risk factors
- end stage renal disease
- chronic kidney disease
- ejection fraction
- newly diagnosed
- hematopoietic stem cell
- peritoneal dialysis
- cell therapy
- mental health
- bone marrow
- dendritic cells
- acute myeloid leukemia
- prognostic factors
- emergency department
- mass spectrometry
- stem cells
- high resolution
- immune response
- mesenchymal stem cells
- patient reported
- kidney transplantation