CART CELL THERAPY BLACK SHADOW IN HEMATOLOGICAL DISORDERS : SYSTEMIC REVIEW WITH META-ANALYSIS

Abstract

To determine the effect of CART therapy on hypogammaglobulinemia and bone marrow aplasia, and to determine the probable medications in management of hypogammaglobulinemia with other associated risk factors and complications. Systematic search was conducted in 4 databases using the terms CART therapy, haematological malignancies, and hypogammaglobulinemia. Articles including patients with any haematological malignancies undergone CART therapy and assessment done on hypogammaglobulinemia were included. Following screening and selection of the articles, narrative synthesis, quality assessment, and meta-analysis were conducted 1197 citations , 9 were finally included for meta-analysis comprising of 425 patients who were affected due to any haematological malignancies and had undergone CART therapy. The overall incidence rate was 35.35%. In all the studies, hypogammaglobulinemia was managed using IgG. Most of the patients across the studies had infection due to reduction in WBC count. The overall incidence of neutropenia following CART therapy was 59% lymphopenia was 82%,and B-cell aplasia was 49.5%. The effective way for management of hypogammaglobulinemia was using IgA antibody. The overall incidence of hypogammaglobulinemia and WBCs was difficult to conclude as majority of the studies were of low and fair quality and were collected at different time points after administration of CART therapy. Thus, good quality clinical trials, open label trials or RCT are required. Hypogammaglobulinemia increases with a decrease in neutrophils, lymphocytes, and B-type cells leading to variable infection.