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Thrombopoietin receptor agonists for acquired thrombocytopenia following anti-CD19 CAR-T-cell therapy: a case report

Chimeric antigen receptor (CAR)-modified T-cells targeting CD19 represent a promising therapy for relapsed or refractory (r/r) lymphoma and leukemia. The most common adverse events are immune related and include cytokine release syndrome and neurotoxicity. However, early and late hematological toxic...

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Autores principales: Baur, Rebecca, Jitschin, Regina, Kharboutli, Soraya, Stoll, Andrej, Völkl, Simon, Büttner-Herold, Maike, Schmidt, Daniela, Rösler, Wolf, Mackensen, Andreas, Mougiakakos, Dimitrios
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8287610/
https://www.ncbi.nlm.nih.gov/pubmed/34272307
http://dx.doi.org/10.1136/jitc-2021-002721
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author Baur, Rebecca
Jitschin, Regina
Kharboutli, Soraya
Stoll, Andrej
Völkl, Simon
Büttner-Herold, Maike
Schmidt, Daniela
Rösler, Wolf
Mackensen, Andreas
Mougiakakos, Dimitrios
author_facet Baur, Rebecca
Jitschin, Regina
Kharboutli, Soraya
Stoll, Andrej
Völkl, Simon
Büttner-Herold, Maike
Schmidt, Daniela
Rösler, Wolf
Mackensen, Andreas
Mougiakakos, Dimitrios
author_sort Baur, Rebecca
collection PubMed
description Chimeric antigen receptor (CAR)-modified T-cells targeting CD19 represent a promising therapy for relapsed or refractory (r/r) lymphoma and leukemia. The most common adverse events are immune related and include cytokine release syndrome and neurotoxicity. However, early and late hematological toxicity has emerged as a substantial clinical hurdle leading among others to an increased risk for infections or bleeding. The underlying pathophysiology remains elusive and supportive measures comprise stem cell support or the use of growth factors. Here, we report a 66-year-old woman with r/r diffuse large B-cell lymphoma that received anti-CD19 CAR-T-cells achieving a complete metabolic remission. At month 3 after adoptive cell transfer, the patient still exhibited a grade 3 anemia and a grade 4 thrombocytopenia. The latter required regular platelet transfusions. Bone marrow smear revealed hypocellularity without dysplasia. Despite reduced megakaryopoiesis, immature platelet fraction was elevated indicating an at least partially consumptive underlying component. Based on the successful use of Romiplostim, a thrombopoietin receptor-agonist, in aplastic anemia and immune thrombocytopenia, we treated our patient accordingly. Platelet count (and hemoglobin levels) increased and the patient remains transfusion-free. Taken together, our therapeutic approach could represent a novel strategy for managing CAR-T-cell-related hematotoxicity but, self-evidently, requires further controlled clinical studies.
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spelling pubmed-82876102021-07-30 Thrombopoietin receptor agonists for acquired thrombocytopenia following anti-CD19 CAR-T-cell therapy: a case report Baur, Rebecca Jitschin, Regina Kharboutli, Soraya Stoll, Andrej Völkl, Simon Büttner-Herold, Maike Schmidt, Daniela Rösler, Wolf Mackensen, Andreas Mougiakakos, Dimitrios J Immunother Cancer Case Report Chimeric antigen receptor (CAR)-modified T-cells targeting CD19 represent a promising therapy for relapsed or refractory (r/r) lymphoma and leukemia. The most common adverse events are immune related and include cytokine release syndrome and neurotoxicity. However, early and late hematological toxicity has emerged as a substantial clinical hurdle leading among others to an increased risk for infections or bleeding. The underlying pathophysiology remains elusive and supportive measures comprise stem cell support or the use of growth factors. Here, we report a 66-year-old woman with r/r diffuse large B-cell lymphoma that received anti-CD19 CAR-T-cells achieving a complete metabolic remission. At month 3 after adoptive cell transfer, the patient still exhibited a grade 3 anemia and a grade 4 thrombocytopenia. The latter required regular platelet transfusions. Bone marrow smear revealed hypocellularity without dysplasia. Despite reduced megakaryopoiesis, immature platelet fraction was elevated indicating an at least partially consumptive underlying component. Based on the successful use of Romiplostim, a thrombopoietin receptor-agonist, in aplastic anemia and immune thrombocytopenia, we treated our patient accordingly. Platelet count (and hemoglobin levels) increased and the patient remains transfusion-free. Taken together, our therapeutic approach could represent a novel strategy for managing CAR-T-cell-related hematotoxicity but, self-evidently, requires further controlled clinical studies. BMJ Publishing Group 2021-07-16 /pmc/articles/PMC8287610/ /pubmed/34272307 http://dx.doi.org/10.1136/jitc-2021-002721 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Case Report
Baur, Rebecca
Jitschin, Regina
Kharboutli, Soraya
Stoll, Andrej
Völkl, Simon
Büttner-Herold, Maike
Schmidt, Daniela
Rösler, Wolf
Mackensen, Andreas
Mougiakakos, Dimitrios
Thrombopoietin receptor agonists for acquired thrombocytopenia following anti-CD19 CAR-T-cell therapy: a case report
title Thrombopoietin receptor agonists for acquired thrombocytopenia following anti-CD19 CAR-T-cell therapy: a case report
title_full Thrombopoietin receptor agonists for acquired thrombocytopenia following anti-CD19 CAR-T-cell therapy: a case report
title_fullStr Thrombopoietin receptor agonists for acquired thrombocytopenia following anti-CD19 CAR-T-cell therapy: a case report
title_full_unstemmed Thrombopoietin receptor agonists for acquired thrombocytopenia following anti-CD19 CAR-T-cell therapy: a case report
title_short Thrombopoietin receptor agonists for acquired thrombocytopenia following anti-CD19 CAR-T-cell therapy: a case report
title_sort thrombopoietin receptor agonists for acquired thrombocytopenia following anti-cd19 car-t-cell therapy: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8287610/
https://www.ncbi.nlm.nih.gov/pubmed/34272307
http://dx.doi.org/10.1136/jitc-2021-002721
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