Bleeding and thrombosis associated with CAR-T therapy

This article comes from NEJM Journal Watch Adverse Events Associated with CAR-T Therapy and CAR-T therapy-related adverse events.
Comment Author: Brady Stein, MD, MHS bleeding or thrombosis occurs in some patients, especially in patients Patients with high-grade ICANS
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Chimeric antigen receptor T cell (CAR-T) therapy has a profound impact on patients with chemotherapy-refractory B-cell lymphoma or acute B-lymphocytic leukemia (B-ALL), and it seems to be manifested in the treatment of multiple myeloma Out the prospects
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The therapy is currently known to be associated with certain toxicities, including cytokine release syndrome and immune effector cell-related neurotoxicity syndrome (ICANS)
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However, we do not yet know whether CAR-T therapy increases the risk of bleeding or thrombosis
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To answer this question, the researchers conducted a retrospective single-center analysis of 111 patients with relapsed or refractory diffuse large B-cell lymphoma and 16 patients with B-ALL.
All patients received CAR-T treatment.

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Of these, 89 patients were treated with axi-cel, and 38 patients were treated with the bispecific CD 19/22 CAR construct
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Important research results are as follows: 12 patients (9.
4%) experienced bleeding events defined by the study protocol within 1 month after receiving CAR-T treatment; 7 events occurred after the patients were discharged from the hospital
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Bleeding events included 6 cases of gross hematuria, 2 cases of soft tissue hemorrhage, 2 cases of subdural hematoma, 1 case of gastrointestinal bleeding and 1 case of hemoptysis
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In the multivariate analysis, only baseline thrombocytopenia was associated with bleeding events
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High-grade ICANS are associated with bleeding and coagulation abnormalities, including prolonged prothrombin time, decreased fibrinogen, and increased d-dimer
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Eight patients (6.
3%) had thrombotic events within 3 months after receiving treatment, including 5 cases of deep vein thrombosis, 2 cases of visceral vein thrombosis, and 1 case of stroke
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High-level ICANS are associated with thrombosis
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Anticoagulant therapy has nothing to do with bleeding events
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Comment This article introduces a relatively unknown toxicity of CAR-T therapy and identifies patients who need close follow-up, especially those with baseline thrombocytopenia or higher grade ICANS
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In view of the relatively low incidence of thrombosis, it is difficult to determine the specific characteristics of patients related to the risk of thrombosis with the exception of ICANS
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The results of this study helped us to further understand the adverse events related to CAR-T therapy.
In addition, it showed that the study population was well tolerated by anticoagulation therapy, which made us relieved to a certain extent
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Reviewed article Johnsrud A et al.
Incidence and risk factors associated with bleeding and thrombosis following chimeric antigen receptor T-cell therapy.
Blood Adv 2021 Nov 9; 5:4465.
(https://doi.
org/10.
1182/bloodadvances.
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