Autologous stem cell boost improves persistent immune effector cell associated hematotoxicity following BCMA directed chimeric antigen receptor T (CAR T) cell therapy in multiple myeloma.

Abstract

Persistent Immune Effector Cell Associated Hematotoxicity (ICAHT) is a significant side effect of BCMA CAR T-Cell therapy in patients with relapsed multiple myeloma (MM). The use of stem cell boosts in ICAHT has been described, however studies have been limited by small patient numbers and short follow up. Herein, we report on our multi-institutional experience of ICAHT, defined by an absolute neutrophil count (ANC) of ≤ 1000, thrombocytopenia with a platelet count ≤ 50,000 or/and anemia as hemoglobin (hgb) ≤9 g/dL, in patients who received BCMA CAR T therapy, and the effects of subsequent stem cell boost on hematopoietic reconstitution and clinical outcome. In this study, ICAHT was observed in 60% (n = 61/101) of patients at D + 21, and risk factors for its development included history of a prior ASCT, higher number of prior lines of therapy, a decreased platelet count prior to lymphodepletion and history of ICANS. 28% of patients with ICAHT received a stem cell boost at a median of 116 days due to profound and prolonged cytopenias often requiring ongoing transfusion support. Stem cell boost significantly improved cytopenias at 3 and 6 months follow up without any adverse effects on PFS and OS, underscoring the safety of this procedure.

• Authors: Meera Mohan, Aniko Szabo, Anannya Patwari, Jean Esselmann, Tanvi Patel, Ramya Bachu, Lisa E Rein, Abhishek Janardan, Vineel Bhatlapenumarthi, Evanka Annyapu, Catherine Skoog, Areyl Goff, Samer Al Hadidi, Sabarinath Venniyil Radhakrishnan, Sharmilan Thanendrarajan, Maurizio Zangari, Nirav Shah, Frits van Rhee, Binod Dhakal, Mehdi Hamadani, Anita D'Souza, Carolina Schinke
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 59 Issue 5 Pg. 647-652 (May 2024) ISSN: 1476-5365 [Electronic] England
• PMID: 38361116 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2024. The Author(s), under exclusive licence to Springer Nature Limited.

Chemical References

• B-Cell Maturation Antigen
• Receptors, Chimeric Antigen

Topics

• Humans
• Multiple Myeloma (therapy)
• Male
• Female
• Middle Aged
• B-Cell Maturation Antigen
• Aged
• Immunotherapy, Adoptive (methods, adverse effects)
• Transplantation, Autologous
• Adult
• Hematopoietic Stem Cell Transplantation (methods)
• Receptors, Chimeric Antigen