Cytopenias After CD19 Chimeric Antigen Receptor T-Cells (CAR-T) Therapy for Diffuse Large B-Cell Lymphomas or Transformed Follicular Lymphoma: A Single Institution Experience

Abstract

Introduction

Patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) have poor outcomes. Treatment with CD19 chimeric antigen receptor (CAR-T) cells, tisagenlecleucel and axicabtagene ciloleucel, has been associated with improved outcomes. Cytopenias were observed in clinical trials with both products; however, little is known regarding the patterns and outcomes of these cytopenias.

Subjects and Methods

We reviewed DLBCL patients (n=32) receiving either product between January and September 2018 at our institution.

Results

Median duration of leukopenia, neutropenia, lymphopenia, anemia, and thrombocytopenia was 49, 9, 117.5, 125, and 95.5 days after CAR-T infusion, respectively. Filgrastim was used in 63% of patients, and 50% of patients received red cell or platelet transfusions. With the exception of neutropenia, increase in the duration of cytopenia of any lineage was associated with improvement in progression-free survival, and in overall survival in case of anemia. There was no association between the duration of cytopenias with either cytokine release syndrome or neurotoxicity.

Discussion

Our data suggest a correlation between cytopenias and survival outcomes after CD19 CAR-T therapy. If validated, cytopenia may be proven useful as a biomarker of response and survival after CAR-T therapy.

Keywords:

• diffuse large B-cell lymphoma
• transformed follicular lymphomas
• chimeric antigen receptor T-cells
• immunotherapy
• cytopenias

Disclosure

Dr Adam Kittai reports personal fees from Bristol-Myers Squibb, outside the submitted work. Dr Ayman Saad reports personal fees from Magenta Therapeutics, Incyte pharamceuticals, and CareDx, outside the submitted work. Dr Samantha M Jaglowski reports grants and/or personal fees from Novartis, Kite, CRISPR Therapeutics, Takeda, Juno, and Unum Therapeutics, during the conduct of the study. The authors report no other conflicts of interest in this work.