Find in Library
Search millions of books, articles, and more
Indexed Open Access Databases
Safety of allogeneic hematopoietic cell transplant in adults after CD19-targeted CAR T-cell therapy
oleh: Mazyar Shadman, Jordan Gauthier, Kevin A. Hay, Jenna M. Voutsinas, Filippo Milano, Ang Li, Alexandre V. Hirayama, Mohamed L. Sorror, Sindhu Cherian, Xueyan Chen, Ryan D. Cassaday, Brian G. Till, Ajay K. Gopal, Brenda M. Sandmaier, David G. Maloney, Cameron J. Turtle
Format: | Article |
---|---|
Diterbitkan: | Elsevier 2019-10-01 |
Deskripsi
Abstract: Allogeneic hematopoietic cell transplantation (allo-HCT) is offered to selected patients after chimeric antigen receptor–modified T-cell (CAR-T) therapy. Lymphodepleting chemotherapy and CAR-T therapy have immunosuppressive and immunomodulatory effects that could alter the safety profile of subsequent allo-HCT. We reviewed our experience with 32 adults (acute lymphoblastic leukemia [ALL], n = 19; B-cell non-Hodgkin lymphoma [NHL]/chronic lymphocytic leukemia [CLL], n = 13) who received an allo-HCT after CAR-T therapy, with a focus on posttransplant toxicities. Myeloablative conditioning (MAC) was used in 74% of ALL patients and 39% of NHL/CLL patients. The median time from CAR-T therapy to allo-HCT was 72 days in ALL patients and 122 days in NHL/CLL patients. Cumulative incidences of grade 3-4 acute graft-versus-host disease (GVHD) and chronic GVHD were 25% and 10%, respectively. All patients had neutrophil recovery (median, 18.5 days) and all but 3 had platelet recovery (median, 12 days). Twenty-two percent had viral or systemic fungal infection within 100 days after allo-HCT. The 100-day and 1-year cumulative incidences of NRM were 16% and 21%, respectively, for ALL patients and 15% and 33%, respectively, for NHL/CLL patients. In ALL patients, later utilization of allo-HCT after CAR-T therapy was associated with higher mortality. In NHL/CLL patients, MAC was associated with higher mortality. Toxicities did not exceed the expected incidences in this high-risk population.