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

Abstract

AbstractChimeric antigen receptor (CAR)‐reprogrammed T cell therapy is a novel and powerful treatment against hematological malignancies. Cytokine release syndrome (CRS) and other potentially life‐threatening toxicities are known side effects which need appropriate management and supportive care. Coagulopathy is a common and severe CAR‐T‐related adverse event, while a comprehensive profile of coagulopathy in patients with multiple myeloma (MM) undergoing CAR‐T cell therapy has not been reported. Therefore, we performed a comprehensive analysis of coagulopathy in 51 patients with r/r MM given anti‐B cell maturation antigen CAR‐T cell therapy. We found that 49% of patients had coagulation disorders, and 29% of patients experienced disseminated intravascular coagulation (DIC). Severe CRS, abnormal liver function and higher tumor burden were risk factors for the CAR‐T‐related coagulopathy. We found that the serum IL‐6 level and alanine aminotransferase level were potential indicators for CAR‐T‐related DIC. Furthermore, we found that coagulation disorders occurred within 1 month after CAR‐T cell infusion, mainly between days 10 and 13, which was 2−5 days later than the beginning of CRS and simultaneous with the beginning of abnormal liver function and the peak of CRS. In addition, although patients with coagulation dysfunction had a trend for better outcomes and prognosis, no statistical significance was found. In conclusion, our research provided a comprehensive understanding of CAR‐T‐related coagulopathy in MM. Upon timely and standardized treatment, coagulopathy was manageable in most cases.