Prolonged Cytopenia with CAR-T Cell Therapy and Management Recommendations.

Q4 Health Professions
Clinical hematology international Pub Date : 2025-03-26 eCollection Date: 2025-01-01 DOI:10.46989/001c.126463
Debolanle Dahunsi, Cynthia Eleanya, Akintomiwa Akintunde, Olalekan Oluwole
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引用次数: 0

Abstract

Chimeric antigen receptor T-cell (CAR T-cell) therapy has revolutionized the treatment of lymphoid malignancies. Prolonged cytopenias, though poorly understood, have emerged as important considerations in the treatment process. In this review, we classified cytopenias into early (< 30 days post CAR T infusion), and late-occurring (after day 30 post infusion). We identified previous chemotherapy and lymphodepletion chemotherapy as the major risk factors contributing to early cytopenia. Product characteristics, such as costimulatory domains, and side effects of therapy such as cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS) were identified as contributing factors to prolonged cytopenias occurring more than 30 days post CAR-T infusion. We recommend close monitoring with frequent checks, enhanced care with granulocyte colony stimulating factor (GCSF) support for grade 3-4 neutropenia, blood transfusion for severe anemia (Hb < 7g/dL), platelets for severe thrombocytopenia (< 10,000/µL) and thrombopoietin (TPO) mimetics such as eltrombopag or romiplostim for prolonged severe thrombocytopenia in patients at high-risk of hemorrhagic complications.

CAR-T细胞治疗延长细胞减少症和管理建议。
嵌合抗原受体t细胞(CAR - t细胞)疗法已经彻底改变了淋巴细胞恶性肿瘤的治疗。延长的细胞减少症,虽然知之甚少,已成为治疗过程中的重要考虑因素。在这篇综述中,我们将细胞减少分为早期(CAR - T输注后< 30天)和晚期(输注后30天)。我们发现以前的化疗和淋巴细胞耗竭化疗是导致早期细胞减少的主要危险因素。产品特性,如共刺激结构域,以及治疗的副作用,如细胞因子释放综合征(CRS)和免疫效应细胞相关神经毒性综合征(ICANS),被认为是导致CAR-T输注后超过30天出现延长的细胞减少的因素。我们建议密切监测,经常检查,加强护理,为3-4级中性粒细胞减少症提供粒细胞集落刺激因子(GCSF)支持,为严重贫血(Hb < 7g/dL)输血,为严重血小板减少症(< 10,000/µL)提供血小板,为出血并发症高风险患者的长期严重血小板减少症提供血小板生成素(TPO)模拟物,如eltrombopag或romiplostim。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
1.30
自引率
0.00%
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0
审稿时长
20 weeks
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