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Immune effector cell-associated hematotoxicity: EHA/EBMT consensus grading and best practice recommendations.
Rejeski, Kai; Subklewe, Marion; Aljurf, Mahmoud; Bachy, Emmanuel; Balduzzi, Adriana; Barba, Pere; Bruno, Benedetto; Benjamin, Reuben; Carrabba, Matteo G; Chabannon, Christian; Ciceri, Fabio; Corradini, Paolo; Delgado, Julio; Di Blasi, Roberta; Greco, Raffaella; Houot, Roch; Iacoboni, Gloria; Jäger, Ulrich; Kersten, Marie José; Mielke, Stephan; Nagler, Arnon; Onida, Francesco; Peric, Zinaida; Roddie, Claire; Ruggeri, Annalisa; Sánchez-Guijo, Fermín; Sánchez-Ortega, Isabel; Schneidawind, Dominik; Schubert, Maria-Luisa; Snowden, John A; Thieblemont, Catherine; Topp, Max; Zinzani, Pier Luigi; Gribben, John G; Bonini, Chiara; Sureda, Anna; Yakoub-Agha, Ibrahim.
Afiliación
  • Rejeski K; Department of Medicine III, LMU University Hospital, LMU Munich, Munich, Germany.
  • Subklewe M; Department of Medicine III, LMU University Hospital, LMU Munich, Munich, Germany.
  • Aljurf M; Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
  • Bachy E; Department of Hematology, Hospices Civils de Lyon and Université Claude Bernard Lyon 1, Lyon, France.
  • Balduzzi A; Pediatric Transplantation Unit, Department of Medicine and Surgery, University of Milan-Bicocca-Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
  • Barba P; Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology, Barcelona, Spain.
  • Bruno B; Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.
  • Benjamin R; Division of Hematology and Cell Therapy Unit, Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy.
  • Carrabba MG; School of Cancer & Pharmaceutical Sciences, King's College London, London, United Kingdom.
  • Chabannon C; Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Hospital, Milan, Italy.
  • Ciceri F; Institut Paoli-Calmettes Comprehensive Cancer Centre and Module Biothérapies du Centre d'Investigations Cliniques de Marseille, INSERM-Aix-Marseille Université-AP-HM-IPC, CBT-1409, Marseille, France.
  • Corradini P; Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Hospital, Milan, Italy.
  • Delgado J; Division of Hematology and Stem Cell Transplantation, Fondazione IRCCS Instituto Nazionale dei Tumori, University of Milan, Milan, Italy.
  • Di Blasi R; Oncoimmunotherapy Unit, Department of Hematology, Hospital Clinic de Barcelona, Barcelona, Spain.
  • Greco R; Université de Paris, Assistance Publique-Hopitaux de Paris, Service d'hémato-oncologie, Paris, France.
  • Houot R; Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Hospital, Milan, Italy.
  • Iacoboni G; Department of Hematology, CHU Rennes, University of Rennes, INSERM U1236, Rennes, France.
  • Jäger U; Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology, Barcelona, Spain.
  • Kersten MJ; Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.
  • Mielke S; Department of Medicine I, Medical University of Vienna, Vienna, Austria.
  • Nagler A; Department of Hematology, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
  • Onida F; Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Department of Laboratory Medicine and Medicine Huddinge, Karolinska University Hospital and Institute, Stockholm, Sweden.
  • Peric Z; Division of Hematology, Chaim Sheba Medical Center, Tel Aviv University, Tel-Hashomer, Israel.
  • Roddie C; Hematology and Bone Marrow Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
  • Ruggeri A; Department of Hematology, University Hospital Centre Zagreb, Zagreb, Croatia.
  • Sánchez-Guijo F; Department of Hematology, University College London Hospital, London, United Kingdom.
  • Sánchez-Ortega I; Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Hospital, Milan, Italy.
  • Schneidawind D; University of Salamanca, IBSAL-University Hospital of Salamanca, Salamanca, Spain.
  • Schubert ML; Executive Office, European Society for Blood and Marrow Transplantation, Barcelona, Spain.
  • Snowden JA; Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland.
  • Thieblemont C; Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany.
  • Topp M; Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
  • Zinzani PL; Université de Paris, Assistance Publique-Hopitaux de Paris, Service d'hémato-oncologie, Paris, France.
  • Gribben JG; Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany.
  • Bonini C; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy.
  • Sureda A; Barts Cancer Institute, Queen Mary, University of London, London, United Kingdom.
  • Yakoub-Agha I; Division of Immunology, Transplantation and Infectious Disease, Experimental Hematology Unit, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.
Blood ; 142(10): 865-877, 2023 09 07.
Article en En | MEDLINE | ID: mdl-37300386
Hematological toxicity is the most common adverse event after chimeric antigen receptor (CAR) T-cell therapy. Cytopenias can be profound and long-lasting and can predispose for severe infectious complications. In a recent worldwide survey, we demonstrated that there remains considerable heterogeneity in regard to current practice patterns. Here, we sought to build consensus on the grading and management of immune effector cell-associated hematotoxicity (ICAHT) after CAR T-cell therapy. For this purpose, a joint effort between the European Society for Blood and Marrow Transplantation (EBMT) and the European Hematology Association (EHA) involved an international panel of 36 CAR T-cell experts who met in a series of virtual conferences, culminating in a 2-day meeting in Lille, France. On the basis of these deliberations, best practice recommendations were developed. For the grading of ICAHT, a classification system based on depth and duration of neutropenia was developed for early (day 0-30) and late (after day +30) cytopenia. Detailed recommendations on risk factors, available preinfusion scoring systems (eg, CAR-HEMATOTOX score), and diagnostic workup are provided. A further section focuses on identifying hemophagocytosis in the context of severe hematotoxicity. Finally, we review current evidence and provide consensus recommendations for the management of ICAHT, including growth factor support, anti-infectious prophylaxis, transfusions, autologous hematopoietic stem cell boost, and allogeneic hematopoietic cell transplantation. In conclusion, we propose ICAHT as a novel toxicity category after immune effector cell therapy, provide a framework for its grading, review literature on risk factors, and outline expert recommendations for the diagnostic workup and short- and long-term management.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trasplante de Células Madre Hematopoyéticas / Hematología Tipo de estudio: Guideline / Prognostic_studies / Risk_factors_studies Idioma: En Revista: Blood Año: 2023 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trasplante de Células Madre Hematopoyéticas / Hematología Tipo de estudio: Guideline / Prognostic_studies / Risk_factors_studies Idioma: En Revista: Blood Año: 2023 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Estados Unidos