Transfusion needs after CAR T-cell therapy for large B-cell lymphoma: predictive factors and outcome (a DESCAR-T study)

Author:

Vic Samuel1ORCID,Thibert Jean-Baptiste2ORCID,Bachy Emmanuel3ORCID,Cartron Guillaume4ORCID,Gastinne Thomas5,Morschhauser Franck6ORCID,Le Bras Fabien7,Bouabdallah Kamal8,Despas Fabien9,Bay Jacques-Olivier10,Rubio Marie-Thérèse11,Mohty Mohamad12,Casasnovas Olivier13ORCID,Choquet Sylvain14ORCID,Castilla-Llorente Cristina15,Guidez Stéphanie16ORCID,Loschi Michaël17ORCID,Guffroy Blandine18,Carras Sylvain19ORCID,Drieu La Rochelle Laurianne20,Guillet Mathilde21,Houot Roch22ORCID

Affiliation:

1. 1Department of Hematology, CHU de Rennes, Rennes, France

2. 2Etablissement français du sang Bretagne, Rennes, France

3. 3Hematology Department, CHU Lyon Sud, Pierre Bénite, Lyon, France

4. 4Hematology Department, CHU de Montpellier, Montpellier, France

5. 5Hematology Department CHU de Nantes, Nantes, France

6. 6Department of Hematology CHU de Lille, Université de Lille, Lille, France

7. 7Department of Hematology, Lymphoid Malignancies Unit, CHU Henri Mondor, Créteil, France

8. 8Hematology and Cellular Therapy Department, CHU Bordeaux, Bordeaux, France

9. 9Hematology and Internal Medicine Department, Institut Universitaire du Cancer-Oncopole, CHU de Toulouse, Toulouse, France

10. 10Hematology and Cellular Therapy Department, CHU de Clermont-Ferrand, Clermont-Ferrand, France

11. 11Department of Hematology CHRU Nancy, biopole de l'Université de Lorraine, Nancy, France

12. 12Hematology Department Saint-Antoine Hospital, Sorbonne University, Paris, France

13. 13Department of Hematology and INSERM 1231, CHU Dijon Bourgogne, Dijon, France

14. 14Hematology Department, hôpital de la Pitié-Salpêtrière, Sorbonne Université, Paris, France

15. 15Hematology Department, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France

16. 16Hematology and Cellular Therapy Department, CHU de Poitiers, Poitiers, France

17. 17Hematology Department CHU de Nice, Université Cote d’Azur, Nice, France

18. 18Department of Hematology, Institut de Cancérologie Strasbourg Europe, Strasbourg, France

19. 19Institute for Advanced Biosciences, Hematology Department CHU Grenoble-Alpes, University Grenoble-Alpes, Grenoble, France

20. 20Hematology and Cellular Therapy Department, CHU de Tours, Tours, France

21. 21The Lymphoma Academic Research Organization, Statistics, Pierre-Bénite, France

22. 22Department of Hematology, University Hospital of Rennes, UMR U1236 INSERM, University of Rennes, French Blood Establishment, Rennes, France

Abstract

Abstract Chimeric antigen receptor (CAR) T-cells targeting CD19 have been approved for the treatment of relapse/refractory large B-cell lymphoma. Hematotoxicity is the most frequent CAR T-cell–related adverse event. Transfusion support is a surrogate marker of severe cytopenias. Transfusion affects patients’ quality of life, presents specific toxicities, and is known to affect immunity through the so-called transfusion-related immunomodulation that may affect CAR T-cell efficacy. We analyzed data from 671 patients from the French DESCAR-T registry for whom exhaustive transfusion data were available. Overall, 401 (59.8%) and 378 (56.3%) patients received transfusion in the 6-month period before and after CAR T-cell infusion, respectively. The number of patients receiving transfusion and the mean number of transfused products increased during the 6-month period before CAR T-cell infusion, peaked during the first month after infusion (early phase), and decreased over time. Predictive factors for transfusion at the early phase were age >60 years, ECOG PS ≥2, treatment with axicabtagene ciloleucel, pre–CAR T-cell transfusions, and CAR-HEMATOTOX score ≥2. Predictive factors for late transfusion (between 1 and 6 months after infusion) were pre–CAR T-cell transfusions, CAR-HEMATOTOX score ≥2, ICANS ≥3 (for red blood cells [RBC] transfusion), and tocilizumab use (for platelets transfusion). Early transfusions and late platelets (but not RBC) transfusions were associated with a shorter progression-free survival and overall survival. Lymphoma-related mortality and nonrelapse mortality were both increased in the transfused population. Our data shed light on the mechanisms of early and late cytopenia and on the potential impact of transfusions on CAR T-cell efficacy and toxicity.

Publisher

American Society of Hematology

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