Lesan Vadim, Christofyllakis Konstantinos, Bewarder Moritz, Thurner Lorenz, Bittenbring Jörg
Department of Hematology and Oncology, Saarland University Hospital, Homburg, Germany.
Front Med (Lausanne). 2024 Nov 18;11:1465802. doi: 10.3389/fmed.2024.1465802. eCollection 2024.
Patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL), mantle cell lymphoma (MCL) and multiple myeloma have poor outcomes. CAR-T completely changed the landscape of therapy options, improving not only response rates but also survival outcomes. Hematological toxicity after chimeric antigen receptor therapy (CAR-T) is of increasing interest, being a recognized prognostic factor in this setting. We report our experience with early hematological toxicity after CAR-T therapy and point some important aspects regarding the Hematotox-Score. We identified a strong negative correlation between Hematotox-Score and platelet count at first day of cytokine release syndrome (CRS). Hematotox-Score was predictive of hemoglobin levels at day 28 after CAR-T. Ferritin remained high after 28 days post CAR-T in patients with high Hematotox-Score. Hematotox-Score did not associate with mortality in our cohort. We did not find any significant association between the hematological parameters (hemoglobin, platelets, and neutrophil counts), ferritin, LDH at first day of CRS and mortality. In conclusion, we demonstrate that Hematotox-Score is predictive of early hematological toxicity after CAR-T. Although, patients with higher degree of hematological toxicities have poorer survival outcomes, Hematotox-Score lacks predictive potential, probably due to its limitations. Further development of hematological scores predicting survival outcome in the context of CAR-T are needed.
复发/难治性弥漫性大B细胞淋巴瘤（DLBCL）、套细胞淋巴瘤（MCL）和多发性骨髓瘤患者的预后较差。嵌合抗原受体T细胞（CAR-T）疗法彻底改变了治疗选择的格局，不仅提高了缓解率，还改善了生存结局。嵌合抗原受体疗法（CAR-T）后的血液学毒性越来越受到关注，是这一情况下公认的预后因素。我们报告了我们在CAR-T治疗后早期血液学毒性方面的经验，并指出了关于血液毒性评分（Hematotox-Score）的一些重要方面。我们发现血液毒性评分与细胞因子释放综合征（CRS）第一天的血小板计数之间存在很强的负相关性。血液毒性评分可预测CAR-T治疗后第28天的血红蛋白水平。血液毒性评分高的患者在CAR-T治疗后28天铁蛋白仍居高不下。在我们的队列中，血液毒性评分与死亡率无关。我们未发现CRS第一天的血液学参数（血红蛋白、血小板和中性粒细胞计数）、铁蛋白、乳酸脱氢酶（LDH）与死亡率之间存在任何显著关联。总之，我们证明血液毒性评分可预测CAR-T治疗后的早期血液学毒性。虽然血液学毒性程度较高的患者生存结局较差，但血液毒性评分可能由于其局限性而缺乏预测潜力。需要进一步开发在CAR-T治疗背景下预测生存结局的血液学评分。
