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Hematologic and lymphatic disorders associated with chimeric antigen receptor T-cell therapy: a pharmacovigilance analysis of the FDA adverse event reporting system (FAERS) database.

作者信息

Zhang Zhenpo, Zheng Jingping, Liang Yankun, Wu Qimin, Ding Chufeng, Ma Lin, Su Ling

机构信息

College of Pharmacy, Jinan University, Guangzhou, Guangdong, China.

School of Food Science and Engineering, South China University of Technology, Guangzhou, Guangdong, China.

出版信息

BMC Cancer. 2025 May 9;25(1):846. doi: 10.1186/s12885-025-14227-4.


DOI:10.1186/s12885-025-14227-4
PMID:40346502
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12063233/
Abstract

BACKGROUND: As the application of Chimeric Antigen Receptor T-cell (CAR-T) therapy in cancer treatment becomes increasingly widespread, associated hematologic and lymphatic system adverse events pose significant challenges to its clinical use. Therefore, we aim to comprehensively investigate and summarize the hematologic and lymphatic system AEs associated with CAR-T therapy. METHODS: We extracted CAR-T-related adverse event reports from the FDA Adverse Event Reporting System (FAERS) database for the period from August 2017 to December 2023. Disproportionality analysis using the Reporting Odds Ratio (ROR) and Information Component (IC) was performed to identify CAR-T-associated hematologic and lymphatic system AEs. We employed LASSO regression analysis to identify hematologic and lymphatic system AEs associated with mortality. RESULTS: In the FAERS database, we identified 1,600 individual case safety reports of hematologic and lymphatic system AEs related to CAR-T therapy. The median age of patients was 57 years (interquartile range [IQR] 32-67), with fatal outcomes in 15.3% of cases. We identified 25 significant adverse event signals associated with CAR-T therapy. B-cell aplasia (ROR025 = 1054.56, IC025 = 4.74), cytopenia (ROR025 = 17.27, IC025 = 3.81), hypofibrinogenemia (ROR025 = 100.18, IC025 = 2.46), anemia (ROR025 = 1.87, IC025 = 0.59), febrile bone marrow aplasia (ROR025 = 55.32, IC025 = 2.70), and pancytopenia (ROR025 = 7.18, IC025 = 1.42) were the most significant hematologic and lymphatic system AEs for tisa-cel, axi-cel, brexu-cel, liso-cel, ide-cel, and cilta-cel, respectively. Most hematologic and lymphatic system AEs occurred within 10 days post-CAR-T infusion. Hematologic and lymphatic system AEs were associated with a mortality rate of 15.3%. Our analysis revealed 15 hematologic and lymphatic system AEs closely associated with mortality in CAR-T-treated patients, including splenic hemorrhage, disseminated intravascular coagulation, and pancytopenia. CONCLUSIONS: Our study found that hematologic and lymphatic system AEs were more closely associated with anti-CD19 CAR-T and CAR-T containing CD28. Splenic hemorrhage, disseminated intravascular coagulation, and pancytopenia were identified as hematologic and lymphatic system AEs that, while less frequently reported clinically, were highly associated with mortality.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/51e1/12063233/826b198b805b/12885_2025_14227_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/51e1/12063233/2233826727e1/12885_2025_14227_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/51e1/12063233/534ebed28be3/12885_2025_14227_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/51e1/12063233/36fdf4590425/12885_2025_14227_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/51e1/12063233/975089a877dc/12885_2025_14227_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/51e1/12063233/826b198b805b/12885_2025_14227_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/51e1/12063233/2233826727e1/12885_2025_14227_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/51e1/12063233/534ebed28be3/12885_2025_14227_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/51e1/12063233/36fdf4590425/12885_2025_14227_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/51e1/12063233/975089a877dc/12885_2025_14227_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/51e1/12063233/826b198b805b/12885_2025_14227_Fig5_HTML.jpg

相似文献

[1]
Hematologic and lymphatic disorders associated with chimeric antigen receptor T-cell therapy: a pharmacovigilance analysis of the FDA adverse event reporting system (FAERS) database.

BMC Cancer. 2025-5-9

[2]
Safety assessment of anti-B cell maturation antigen chimeric antigen receptor T cell therapy: a real-world study based on the FDA adverse event reporting system database.

Front Immunol. 2024

[3]
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[4]
Hemophagocytic lymphohistiocytosis and disseminated intravascular coagulation are underestimated, but fatal adverse events in chimeric antigen receptor T-cell therapy.

Haematologica. 2023-8-1

[5]
Neurotoxicity and Rare Adverse Events in BCMA-Directed CAR T Cell Therapy: A Comprehensive Analysis of Real-World FAERS Data.

Transplant Cell Ther. 2025-2

[6]
Chimeric antigen receptor T-cell therapy-induced nervous system toxicity: a real-world study based on the FDA Adverse Event Reporting System database.

BMC Cancer. 2024-1-2

[7]
Disseminated intravascular coagulation is an underestimated but fatal adverse event associated with blinatumomab therapy: A pharmacovigilance analysis of FAERS.

Int J Cancer. 2025-3-1

[8]
CAR-T therapy pulmonary adverse event profile: a pharmacovigilance study based on FAERS database (2017-2023).

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[9]
Hematological toxicities in immune checkpoint inhibitors: A pharmacovigilance study from 2014 to 2019.

Hematol Oncol. 2020-6-9

[10]
Cardiovascular toxicity profiles of immune checkpoint inhibitors with or without angiogenesis inhibitors: a real-world pharmacovigilance analysis based on the FAERS database from 2014 to 2022.

Front Immunol. 2023

本文引用的文献

[1]
Timing of Toxicities and Non-Relapse Mortality Following CAR T Therapy in Myeloma.

Transplant Cell Ther. 2024-9

[2]
Real-World Outcomes with Chimeric Antigen Receptor T Cell Therapies in Large B Cell Lymphoma: A Systematic Review and Meta-Analysis.

Transplant Cell Ther. 2024-1

[3]
Chimeric antigen receptor T-cell immunotherapies adverse events reported to FAERS database: focus on cytopenias.

Leuk Lymphoma. 2023-12

[4]
A comprehensive analysis of coagulopathy during anti-B cell maturation antigen chimeric antigen receptor-T therapy in multiple myeloma, a retrospective study based on LEGEND-2.

Hematol Oncol. 2023-10

[5]
Psychiatric disorders associated with immune checkpoint inhibitors: a pharmacovigilance analysis of the FDA Adverse Event Reporting System (FAERS) database.

EClinicalMedicine. 2023-4-21

[6]
How I treat cytopenias after CAR T-cell therapy.

Blood. 2023-5-18

[7]
Hemophagocytic lymphohistiocytosis and disseminated intravascular coagulation are underestimated, but fatal adverse events in chimeric antigen receptor T-cell therapy.

Haematologica. 2023-8-1

[8]
Cytopenias following anti-CD19 chimeric antigen receptor (CAR) T cell therapy: a systematic analysis for contributing factors.

Ann Med. 2022-12

[9]
The pathogenesis, diagnosis, prevention, and treatment of CAR-T cell therapy-related adverse reactions.

Front Pharmacol. 2022-10-14

[10]
A real-world comparison of tisagenlecleucel and axicabtagene ciloleucel CAR T cells in relapsed or refractory diffuse large B cell lymphoma.

Nat Med. 2022-10

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