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The CAR-HEMATOTOX score as a prognostic model of toxicity and response in patients receiving BCMA-directed CAR-T for relapsed/refractory multiple myeloma
BACKGROUND: BCMA-directed CAR T-cell therapy (CAR-T) has altered the treatment landscape of relapsed/refractory (r/r) multiple myeloma, but is hampered by unique side effects that can lengthen hospital stays and increase morbidity. Hematological toxicity (e.g. profound and prolonged cytopenias) repr...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10391746/ https://www.ncbi.nlm.nih.gov/pubmed/37525244 http://dx.doi.org/10.1186/s13045-023-01465-x |
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author | Rejeski, Kai Hansen, Doris K. Bansal, Radhika Sesques, Pierre Ailawadhi, Sikander Logue, Jennifer M. Bräunlein, Eva Cordas dos Santos, David M. Freeman, Ciara L. Alsina, Melissa Theurich, Sebastian Wang, Yucai Krackhardt, Angela M. Locke, Frederick L. Bachy, Emmanuel Jain, Michael D. Lin, Yi Subklewe, Marion |
author_facet | Rejeski, Kai Hansen, Doris K. Bansal, Radhika Sesques, Pierre Ailawadhi, Sikander Logue, Jennifer M. Bräunlein, Eva Cordas dos Santos, David M. Freeman, Ciara L. Alsina, Melissa Theurich, Sebastian Wang, Yucai Krackhardt, Angela M. Locke, Frederick L. Bachy, Emmanuel Jain, Michael D. Lin, Yi Subklewe, Marion |
author_sort | Rejeski, Kai |
collection | PubMed |
description | BACKGROUND: BCMA-directed CAR T-cell therapy (CAR-T) has altered the treatment landscape of relapsed/refractory (r/r) multiple myeloma, but is hampered by unique side effects that can lengthen hospital stays and increase morbidity. Hematological toxicity (e.g. profound and prolonged cytopenias) represents the most common grade ≥ 3 toxicity and can predispose for severe infectious complications. Here, we examined the utility of the CAR-HEMATOTOX (HT) score to predict toxicity and survival outcomes in patients receiving standard-of-care idecabtagene vicleucel and ciltacabtagene autoleucel. METHODS: Data were retrospectively collected from 113 r/r multiple myeloma patients treated between April 2021 and July 2022 across six international CAR-T centers. The HT score—composed of factors related to hematopoietic reserve and baseline inflammatory state—was determined prior to lymphodepleting chemotherapy. RESULTS: At lymphodepletion, 63 patients were HT(low) (score 0–1) and 50 patients were HT(high) (score ≥ 2). Compared to their HT(low) counterparts, HT(high) patients displayed prolonged severe neutropenia (median 9 vs. 3 days, p < 0.001), an increased severe infection rate (40% vs. 5%, p < 0.001), and more severe ICANS (grade ≥ 3: 16% vs. 0%, p < 0.001). One-year non-relapse mortality was higher in the HT(high) group (13% vs. 2%, p = 0.019) and was predominantly attributable to fatal infections. Response rates according to IMWG criteria were higher in HT(low) patients (≥ VGPR: 70% vs. 44%, p = 0.01). Conversely, HT(high) patients exhibited inferior progression-free (median 5 vs. 15 months, p < 0.001) and overall survival (median 10.5 months vs. not reached, p < 0.001). CONCLUSIONS: These data highlight the prognostic utility of the CAR-HEMATOTOX score for both toxicity and treatment response in multiple myeloma patients receiving BCMA-directed CAR-T. The score may guide toxicity management (e.g. anti-infective prophylaxis, early G-CSF, stem cell boost) and help to identify suitable CAR-T candidates. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13045-023-01465-x. |
format | Online Article Text |
id | pubmed-10391746 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-103917462023-08-02 The CAR-HEMATOTOX score as a prognostic model of toxicity and response in patients receiving BCMA-directed CAR-T for relapsed/refractory multiple myeloma Rejeski, Kai Hansen, Doris K. Bansal, Radhika Sesques, Pierre Ailawadhi, Sikander Logue, Jennifer M. Bräunlein, Eva Cordas dos Santos, David M. Freeman, Ciara L. Alsina, Melissa Theurich, Sebastian Wang, Yucai Krackhardt, Angela M. Locke, Frederick L. Bachy, Emmanuel Jain, Michael D. Lin, Yi Subklewe, Marion J Hematol Oncol Research BACKGROUND: BCMA-directed CAR T-cell therapy (CAR-T) has altered the treatment landscape of relapsed/refractory (r/r) multiple myeloma, but is hampered by unique side effects that can lengthen hospital stays and increase morbidity. Hematological toxicity (e.g. profound and prolonged cytopenias) represents the most common grade ≥ 3 toxicity and can predispose for severe infectious complications. Here, we examined the utility of the CAR-HEMATOTOX (HT) score to predict toxicity and survival outcomes in patients receiving standard-of-care idecabtagene vicleucel and ciltacabtagene autoleucel. METHODS: Data were retrospectively collected from 113 r/r multiple myeloma patients treated between April 2021 and July 2022 across six international CAR-T centers. The HT score—composed of factors related to hematopoietic reserve and baseline inflammatory state—was determined prior to lymphodepleting chemotherapy. RESULTS: At lymphodepletion, 63 patients were HT(low) (score 0–1) and 50 patients were HT(high) (score ≥ 2). Compared to their HT(low) counterparts, HT(high) patients displayed prolonged severe neutropenia (median 9 vs. 3 days, p < 0.001), an increased severe infection rate (40% vs. 5%, p < 0.001), and more severe ICANS (grade ≥ 3: 16% vs. 0%, p < 0.001). One-year non-relapse mortality was higher in the HT(high) group (13% vs. 2%, p = 0.019) and was predominantly attributable to fatal infections. Response rates according to IMWG criteria were higher in HT(low) patients (≥ VGPR: 70% vs. 44%, p = 0.01). Conversely, HT(high) patients exhibited inferior progression-free (median 5 vs. 15 months, p < 0.001) and overall survival (median 10.5 months vs. not reached, p < 0.001). CONCLUSIONS: These data highlight the prognostic utility of the CAR-HEMATOTOX score for both toxicity and treatment response in multiple myeloma patients receiving BCMA-directed CAR-T. The score may guide toxicity management (e.g. anti-infective prophylaxis, early G-CSF, stem cell boost) and help to identify suitable CAR-T candidates. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13045-023-01465-x. BioMed Central 2023-07-31 /pmc/articles/PMC10391746/ /pubmed/37525244 http://dx.doi.org/10.1186/s13045-023-01465-x Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Rejeski, Kai Hansen, Doris K. Bansal, Radhika Sesques, Pierre Ailawadhi, Sikander Logue, Jennifer M. Bräunlein, Eva Cordas dos Santos, David M. Freeman, Ciara L. Alsina, Melissa Theurich, Sebastian Wang, Yucai Krackhardt, Angela M. Locke, Frederick L. Bachy, Emmanuel Jain, Michael D. Lin, Yi Subklewe, Marion The CAR-HEMATOTOX score as a prognostic model of toxicity and response in patients receiving BCMA-directed CAR-T for relapsed/refractory multiple myeloma |
title | The CAR-HEMATOTOX score as a prognostic model of toxicity and response in patients receiving BCMA-directed CAR-T for relapsed/refractory multiple myeloma |
title_full | The CAR-HEMATOTOX score as a prognostic model of toxicity and response in patients receiving BCMA-directed CAR-T for relapsed/refractory multiple myeloma |
title_fullStr | The CAR-HEMATOTOX score as a prognostic model of toxicity and response in patients receiving BCMA-directed CAR-T for relapsed/refractory multiple myeloma |
title_full_unstemmed | The CAR-HEMATOTOX score as a prognostic model of toxicity and response in patients receiving BCMA-directed CAR-T for relapsed/refractory multiple myeloma |
title_short | The CAR-HEMATOTOX score as a prognostic model of toxicity and response in patients receiving BCMA-directed CAR-T for relapsed/refractory multiple myeloma |
title_sort | car-hematotox score as a prognostic model of toxicity and response in patients receiving bcma-directed car-t for relapsed/refractory multiple myeloma |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10391746/ https://www.ncbi.nlm.nih.gov/pubmed/37525244 http://dx.doi.org/10.1186/s13045-023-01465-x |
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