Abstract
Background: Chimeric antigen receptor T cell (CAR-T) therapy is successful in improving treatment outcomes for relapsed/refractory acute lymphoblastic leukemia (R/R ALL). However, toxicities associated with CAR-T therapy are being increasingly identified. Pancytopenia is one of the most common complications after CAR-T therapy, and platelet transfusions are an essential part of its supportive care. Study Design and Methods: This study aimed to assess the effectiveness of platelet transfusions for R/R ALL patients at our single center and identify associated risk factors. Overall, 44 R/R ALL patients were enrolled in this study, of whom 26 received CAR-T therapy and 18 received salvage chemotherapy. Result: Patients in the CAR-T group had a higher incidence of platelet transfusion refractoriness (PTR) (15/26, 57.7%) than those in the chemotherapy group (3/18, 16.7%) (p = 0.007). For patients receiving CAR-T therapy, multivariate analysis showed that the grade of cytokine release syndrome (CRS) was the only independent risk factor associated with PTR (p = 0.007). Moreover, higher peak serum IL-6 and IFN-γ levels suggested a higher risk of PTR (p = 0.024 and 0.009, respectively). Patients with PTR received more platelet infusion doses than those without PTR (p = 0.0426). Patients with PTR had more grade 3–4 bleeding events than those without PTR (21.4 vs. 0%, p = 0.230), and the cumulative incidence of grade 3–4 bleeding event was different (p = 0.023). Conclusion: We found for the first time that PTR is associated with the CRS grade. Improved knowledge on the mechanisms of PTR after CAR-T therapy is needed to design a rational therapeutic strategy that aims to improve the efficiency of transfusions.
Highlights
Patients with relapsed/refractory acute lymphoblastic leukemia (R/R ALL) usually have a very poor prognosis after salvage chemotherapy, with a median overall survival (OS) of 3–9 months (Zhang et al, 2018)
44 R/R ALL patients aged 15–67 years were enrolled in this study
All data were collected before patients underwent their latest chemotherapy or CAR-T cell infusion
Summary
Patients with relapsed/refractory acute lymphoblastic leukemia (R/R ALL) usually have a very poor prognosis after salvage chemotherapy, with a median overall survival (OS) of 3–9 months (Zhang et al, 2018). Chimeric antigen receptor T-cell (CAR-T) therapy has revolutionized treatment modalities for R/R ALL with a complete remission (CR) rate of 70–90% (Maude et al, 2014; DasGupta et al, 2018; Wei et al, 2018). Pancytopenia is one of the most common complications following CAR-T therapy for R/R ALL. For prophylactic or therapeutic reasons, platelet transfusions are an essential part of the supportive care for patients undergoing CAR-T therapy. Chimeric antigen receptor T cell (CAR-T) therapy is successful in improving treatment outcomes for relapsed/refractory acute lymphoblastic leukemia (R/R ALL). Pancytopenia is one of the most common complications after CAR-T therapy, and platelet transfusions are an essential part of its supportive care
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