Autologous stem cell boost improves persistent immune effector cell associated hematotoxicity following BCMA directed chimeric antigen receptor T (CAR T) cell therapy in multiple myeloma. Bone Marrow Transplant 2024 May;59(5):647-652
Date
02/16/2024Pubmed ID
38361116DOI
10.1038/s41409-024-02233-2Scopus ID
2-s2.0-85185115608 (requires institutional sign-in at Scopus site)Abstract
Persistent Immune Effector Cell Associated Hematotoxicity (ICAHT) is a significant side effect of BCMA CAR T-Cell therapy in patients with relapsed multiple myeloma (MM). The use of stem cell boosts in ICAHT has been described, however studies have been limited by small patient numbers and short follow up. Herein, we report on our multi-institutional experience of ICAHT, defined by an absolute neutrophil count (ANC) of ≤ 1000, thrombocytopenia with a platelet count ≤ 50,000 or/and anemia as hemoglobin (hgb) ≤9 g/dL, in patients who received BCMA CAR T therapy, and the effects of subsequent stem cell boost on hematopoietic reconstitution and clinical outcome. In this study, ICAHT was observed in 60% (n = 61/101) of patients at D + 21, and risk factors for its development included history of a prior ASCT, higher number of prior lines of therapy, a decreased platelet count prior to lymphodepletion and history of ICANS. 28% of patients with ICAHT received a stem cell boost at a median of 116 days due to profound and prolonged cytopenias often requiring ongoing transfusion support. Stem cell boost significantly improved cytopenias at 3 and 6 months follow up without any adverse effects on PFS and OS, underscoring the safety of this procedure.
Author List
Mohan M, Szabo A, Patwari A, Esselmann J, Patel T, Bachu R, Rein LE, Janardan A, Bhatlapenumarthi V, Annyapu E, Skoog C, Goff A, Hadidi SA, Radhakrishnan SV, Thanendrarajan S, Zangari M, Shah N, van Rhee F, Dhakal B, Hamadani M, D'Souza A, Schinke CAuthors
Anita D'Souza MD Associate Professor in the Medicine department at Medical College of WisconsinBinod Dhakal MD Associate Professor in the Medicine department at Medical College of Wisconsin
Anannya Patwari MD Assistant Professor in the Medicine department at Medical College of Wisconsin
Nirav N. Shah MD Associate Professor in the Medicine department at Medical College of Wisconsin
Aniko Szabo PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultAged
B-Cell Maturation Antigen
Female
Hematopoietic Stem Cell Transplantation
Humans
Immunotherapy, Adoptive
Male
Middle Aged
Multiple Myeloma
Transplantation, Autologous
